Form Dd-214 - Application For Certified - State Of California
Download a blank fillable Form Dd-214 - Application For Certified - State Of California in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Dd-214 - Application For Certified - State Of California with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1APPLICATION FOR CERTIFIED COPY OF DD-214
DD-214 Information:
Number of copies requested: ___________
1
Name of Veteran____________________________________________________________________________________
First
Middle
Last
Applicant Information:
Name: _____________________________________________________________________________________________
First
Middle
Last
2
Address: ___________________________________________________________________________________________
Number and Street
City
State
Zip Code
Mailing Address: ____________________________________________________________________________________
Number and Street
City
State
Zip Code
If different than above
Telephone Number: (______)_____________________
With Area Code
Photo ID type:_____________________ID#:_________________________Exp Date:________________
To obtain a Certified Copy of a DD-214 you must be authorized under section 6107 of the Government Code.
Please check the appropriate line below:
___ Person who is subject of the record.
___ Family member or legal representative of person who is subject of the record (must present proper Identification).
3
___ County office that provides veteran’s benefits upon written request of that office.
___ United States Official upon written request of that official.
I, _______________________________ swear under penalty of perjury that I am an authorized person, as defined in
Printed Name
California Government Code Section 6107 and am eligible to receive a certified copy of the record identified on this
4
application form. Sworn this ______ day of ______________________, _________,
at __________________________________________
Signature: ___________________________________
Certificate of Acknowledgement
A notary public or other officer completing this certificate verifies only the identity of the individual who signed
the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of the document
State of________________________
County of ______________________
On ___________ before me, _________________________________, personally appeared ___________________________
(Insert name and title of officer)
personally known to me (or proved to me on the basis of satisfactory evidence) to be the person whose name is
5
subscribed to the within instrument and acknowledged to me that he/she executed the same in his/her authorized
capacity, and that by his/her signature on the instrument the person, or the entity upon behalf of which the person acted,
executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the
foregoing paragraph is true and correct. WITNESS my hand and official seal.
______________________________________
Signature
(seal)
Office use only: Receipt # __________________ Clerk __________________________ Date _______________
Application for Certified Copy of DD-214
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal