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Request for Military Discharge Papers
REQUEST FOR MILITARY DISCHARGE PAPERS
I am requesting ___________ ¨ regular / ¨ certified copy(s) of the following
(Number of copies)
Military Discharge papers: DD214
Name of Veteran: _________________________________________________________
Name of Military Branch:___________________________________________________
Year of Discharge:________________________________________________________
Veteran’s Date of Birth: ___________ OR last four digits of Social Security: _________
Requested by:_____________________________________
Printed Name______________________________________
Signature _________________________________________
Relationship to Veteran
- Self
- Spouse
- Legal Guardian to Military Veteran
- Personal Representative to Military Veteran
- County Veteran’s Service Officer
- Representative of Department of Veteran’s Affairs
- Funeral Home
Requestor’s Mailing Address (Street or P.O. Box, City, State and Zip)
_____________________________________________________
Requestor’s Telephone Number: _____________________________________________
For Staff Use Only- ORS 408.420, 408.425
Required Identification/Photo ID-Driver’s License/ID Card/Military/US Passport.
Expiration Date: ___________________ Document Number: _____________________
Date Processed: _________________________________________________________
Completed by: ___________________________________________________________
