OMB Control No. 3095-0071
Expiration Date: 06-30-2018
SELECTIVE SERVICE SYSTEM RECORDS REQUEST
Year of Birth Prior to 1960
Provide the following information on the registrant and mail this form with any attachmen
National Archives & Record Administration
National Archives – Saint Louis
ATTN: RL-SL
P.O. Box 38757
Saint Louis, MO 63138-0757
DO NOT PROVIDE CREDIT CARD INFORMATION; IF RECORDS ARE FOUND, YOU WILL RECEIVE AN INVOICE FO
ts to:
R PAYMENT
PLEASE PRINT
* Name of Registrant:
Selective Service Number (if known):
* Date of Birth (mm/dd/yyyy):
* Home Address at time of Registration: ____________________________________________________________
Street Address
________________________ ____________________ ____________
City County State
Place of Registration (if known): ____________________________________________________________
Street Address
________________________ ____________________ ____________
City County State
* Record Requested (please check one): Registration Card
Classification Ledger
Registration Card AND Classification Ledger
* Contact Information:
________________
Name: _________________________________ Address: _________________________________________________
Street Address
Te
lephone Number:
_______________________ _______________________________ _____ __________
City State Zip Code
* Mandatory Information – Forms without mandatory information will b ned.
PRIVACY ACT STATE
Collection of this information is authorized by 44 U.S.C. 2104(a). Disclosur s information is voluntary; howev
will be unable to respond to your request if you do not furnish your name an ss, and the minimum required in
regarding the record. The information is used by NARA employees to searc e record, to respond to you, to ma
control over requ
er, we
formation
intain
(06-15) 2
ate preparation of internal statistical reports.
C
ests received and answered, and to facilit
HIVES AND RECORDS ADMINISTR
e retur
MENT
e of thi
d addre
h for th
NATIONAL AR ATION NA FORM 1317
__________________________
Last
__________________________
First
_________________
Middle
