Request For Copy Of Military Discharge Form
ADVERTISEMENT
1REQUEST FOR COPY OF
MILITARY DISCHARGE FORM
_____________ COUNTY
Number of copies requested. _ _ _ _
PLEASE PRINT
VETERAN'S INFORMATION
l. Full Name of Person
First Name
Middle Name
on Record
2. Date of Discharge
Month
Day
Year
4. Date of Birth
Month
Day
Year
5. Social Security
Number
(ifknown)
Last Name
3. Gender
City/County/State
6. Requestor's name _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
7.
Telephone#: _(._ __ _,) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
(MON-FRI 8:00A.M.-5:00P.M.)
CITY
STATE
ZIP
9. Relationship to person named in item 1 : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
9. Purpose for obtaining this r e c o r d : - - - - - - - - - - - - - - - - - - - - - - -
10. Identifying information for discharge record: ID#:. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
11. If copy is to be mailed to some other person, please complete:
Name
Street Address
----------------
-------------------------
C i t y - - - - - - - - - - - State
- - - - - -
Zip Code _ _ _ _ _ _ _ _
Your Signature
Date of Application
OFFICE USE ONLY
Voi./Page _ _ _ _ _ _
Certificate # _ _ _ _
Date Issued
By
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal