Military Release -(Dd214) - Military Discharge Certificate Release Form printable pdf download

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

Military Release -(DD214)

MILITARY DISCHARGE CERTIFICATE RELEASE FORM

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

__________________________________________

City

State

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 __________________________

(Date)

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