Military Discharge Certificate Release Form - Notary Public For The State Of Montana


Military Discharge Certificate Release Form
The following information MUST be completed before a copy or certified copy can be
I, ___________________________________, and being first duly sworn, deposes and upon
his/her oath answers the following: I am entitled to disclosure of the Military Discharge Certificate of:
Service Member Name__________________________________________
Branch of Service______________________________________________
Military Separation Date:_________________________________________
Date of Birth__________________________________________________
recorded in the office of the Park County Clerk & Recorder. I understand that Military Discharge
Certificates are confidential.
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 deceased service member. More specifically, I am the surviving spouse, a
parent, or a descendant of the service member. My relationship to the service member is that of
(No other living person is more closely related to the above mentioned service member.)
 A Mortuary, as defined in 10-2-111, MCA, for the purpose of securing burial benefits.
 A Veteran’s Service Office or a Veteran’s Service Organization, as defined in 10-2-111, MCA.
 Veteran’s affairs division of the MT Dept. of Military Affairs.
 A person who has written authorization (notarized) from the service member or from the next of
kin, if the service member is deceased.
State of Montana
: ss
County of ____________)
Subscribed and sworn to before me this ______day of _________, 20___.
Notary Public for the State of Montana
Printed Name of Notary______________________
Residing at _______________________________
My Commission Expires: ______________________
Mail completed form to:
Park County Clerk & Recorder
414 East Calendar Street
Livingston, MT 59047


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