Military Release -(Dd214) - Military Discharge Certificate Release Form


Military Release -(DD214)
DATE: ___________________________________________
I, ______________________________________________________, swear, depose and state upon my oath, that
(Applicant’s Name)
I am entitled to disclosure of the Military Discharge Certificate of:
( Name of the Service Member of the United States Military )
recorded in the office of the Hill County Clerk and Recorder.
Military Separation Date:_________________________________________
(Approximate year)
Further, that pursuant to Montana Law, I qualify to obtain information from, or, a copy of the Military Discharge
Certificate as: (Please check one)
______ The Service Member who filed the certificate.
______ The next of kin of the service member (if the service member is deceased).
______ A Mortuary, as defined in 10-2-111 MCA, for the purpose of securing burial benefits.
______ A Veteran’s Service Office or a Veterans’ Service Organization, as defined in 10-2-111, MCA.
______ The Veteran’s Affairs Division of the Montana Department of Military Affairs.
______ A person with written authorization (notarized) from the service member or from the next of kin, if
the service member is deceased.
Signature of Applicant
Street or Post Office Address
Zip Code
This instrument was acknowledged before me on _______________, 20____, by ______________________
Signature of Notary Public:__________________________________________
Typed, stamped, or Printed Name of Notary:________________________
(Notary Seal)
Notary Public for the State of Montana
Residing at__________________________________________________
My Commissioner Expires:_____________________________________
OFFICE USE ONLY: Recorded in Book ___________, Page__________ on __________________________


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