Request For Military Discharge Papers Template
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2REQUEST REJECTION NO.____________
REQUEST VERIFICATION NO._______________
REASON:____________________________
RECORD LOCATION_______________________
DATE________________________________
DATE_________________________________
_______________________________________
NORA DIETZEL, RECORDER OF DEEDS
BOONE COUNTY, MISSOURI
(Reserved for Recorder’s Information)
REQUEST FOR MILITARY DISCHARGE PAPERS
Approved by the Recorders Association of Missouri Pursuant to RSMo 59.480
Each Request Form is limited to one record.
1. Record Locator Information:
Veteran: ________________________________________
________________________
__________
Last
First
MI
Filed in:__________________________County, Missouri
*Date of Birth:_______________________
*Branch and Date(s) of Service:
*SSN_______________________________
___________________________________
(*Complete one of the options)
2. Type and number of copies requested:
Number_____Certified Copies
Number _____ Uncertified Copies
3. Authorized Party requesting copy:
Name:___________________________________________
________________________
__________
Last
First
MI
Street Address:__________________________________________________________________________
City, State, Zip:__________________________________________________________________________
Telephone Number:______________________________________________________________________
4. Authorized Statement:
I certify that I am the authorized party pursuant to RSMo 59.480 as stated herein and request the following
of the above named veteran’s record:
1) ________Military Discharge Paper or ___________Filed Request Form
2) Authorization Type: a) ________ Veteran named above; or
b)________ Agent/representative of veteran (Mark appropriate category)
_____Relative (Please state relationship)
____________________________________________________
_____Attorney or Attorney in Fact
_____Government Agency or Court (Please state)
___________________________________________________
_____Funeral Director
_____Other (Please state)___________________________________
____________________________________________________
Date:_______________________
_____________________________________________
Signature of Authorized Party
(Continued on Page 2)
RAM59.480/Rev.82803
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