Application For Dd214 (Military Discharge)
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1
2APPLICATION FOR DD214 (MILITARY DISCHARGE)
The following individuals are authorized to receive a copy of a Military Discharge upon presentation of proper
photo identification and certification of their relationship to the veteran:
Veteran named on the discharge
♦
Family member of the veteran
♦
Legal representative of the veteran
♦
Government Agency that provides Veteran’s benefits
♦
DO NOT WRITE IN THIS
NUMBER OF COPIES
NUMBER OF PAGES
SPACE
Norwalk
District office
Title of Document
DD214 – Military Discharge
Book & Page/Document Number
Name on DD214
Relationship to above
I ____________________________________ certify (or declare) under penalty of perjury under the laws of
the State of California that the foregoing is true and correct.
Date ___________________________
Signature__________________________________________________
DL/ID________________________
Complete your name and address below.
NAME
STREET ADDRESS
CITY
STATE
ZIP CODE
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