APPLICATION FOR COPY OF
MILIT ARY DISCHARGE RECORD
Recorded on
or
after September
1,2003
Number
of
regular copies
~
____
Number
of
certified copies requested
__
_
PLEASE PRINT
VETERAN'S INFORMATION
1.
Full Name
of
Person
on Record
First Name Middle Name
Last Name
2.
Date
of
Discharge
Month Day
Year
4. Date
of
Birth
Month Day
Year
5.
Applicant's
6.
Applicant's
7.
On request and the presentation
of
proper identification, the following persons may inspect or
obtain a copy
ofthe
military discharge record: (Please check the one that applies to you)
D I am the veteran.
D I am the legal guardian
of
the veteran. (Must have certified documentation)
D I am the spouse, child or parent
of
the veteran.
D There is no living spouse, child or parent
of
the veteran and I am the nearest living relative
of
the veteran.
D I
am
the personal representative
of
the estate
of
the veteran. (Must have certified documentation)
D I am the person named by the veteran, legal guardian
of
the veteran, spouse, child or parent
of
the veteran
in
an appropriate power
of
attorney executed
in
accordance with Section 490,
Chapter XII, Texas Probate Code.
(Must have certified documentation)
D I am an employee
of
another governmental body. (Must have employee I.D.)
Identifying information used for person named in item #5:
_______________
_
Supporting documentation used:
_________________________
_
Applicants Signature Date
of
Application
OFFICE USE ONLY
Document
Date ued
1
uty
click to sign
signature
click to edit
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