REQUEST FOR MILITARY SERVICE DISCHARGE RECORD
P
lease note that you must belong to one of the following
categories in order to receive a copy of a discharge record, as
outlined in Public Act 093-0468
Please check the appropriate category…
I am the person named in the document
I am a dependent of the person named in the document
I am Lake County's veteran's service officer
I am a representative of the Department of Veteran's affairs
I am presenting written authorization, containing a notarized
signature, from the person named in the document or from his/her
dependent
I am requesting copies of military service discharge
records for
Veteran’s Date of Birth:
Requests must include a copy of a valid photo identification card
Request made by:
Name (PRINT)
Signature
Address
City, State Zip
Phone Number
Mary Ellen Vanderventer
Lake County Recorder of Deeds
18 N County St – 6
th
Floor
Waukegan, IL 60085-4358
(847) 377-2575
fax (847) 984-5860
Office Hours:
Monday Friday
8:30 a.m. to 5:00 p.m.