Fillable Selective Service Form (National Archives and Records Administration)

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Selective Service Form (National Archives and Records Administration)

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NATIONAL ARCHIVES AND RECORDS ADMINISTRATION NPRC Test Form 11-1 (10/2011)
SELECTIVE SERVICE RECORDS REQUEST
Year of Birth Prior to 1960
Provide the following information on the registrant and mail this form together with any attachments to:
National Archives & Records Administration
National Archives at St. Louis
ATTN: RL-SL
P.O. Box 38757
St. Louis, MO 63138-0757
PLEASE PRINT
* Name of Registrant:
(Last)
(First)
(Middle)
--
--
--
* 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)
* Information Requested/Reason for Request:
* Contact Information:
Name:
Street Address:
City, State, Zip Code:
Telephone Number:
( )
* Mandatory Information – Forms without mandatory information will be returned.
PRIVACY ACT STATEMENT
Collection of this information is authorized by 4 4 U.S.C. 2104(a). Disclosure of the information is voluntary; however, we will be unable to
respond t o yo ur r equest i f you do not f urnish y our n ame and addr ess an d t he m inimum r equired i nformation about t he r ecords. The
information is used by NARA employees to search for the record; to respond to you; to maintain control over information requests received
and answered; and to facilitate preparation of internal statistical reports. If you pr ovide credit card information, that information is used to
bill you for copies.
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Selective Service Form (National Archives and Records Administration)

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Completed 25 July 2020

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