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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

issued.

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.

Signature____________________________________

State of Montana

)

: ss

County of ____________)

Subscribed and sworn to before me this ______day of _________, 20___.

__________________________________________

Notary Public for the State of Montana

(Seal)

Printed Name of Notary______________________

Residing at _______________________________

My Commission Expires: ______________________

Mail completed form to:

Park County Clerk & Recorder

414 East Calendar Street

Livingston, MT 59047

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