FILLABLE FORM
DEPARTMENT OF THE NAVY
FROM:
COMMANDING OFFICER,
TO:
SUBJ:
HONORABLE DISCHARGE FROM THE UNITED STATES NAVY RESERVE
1. YOUR ENLISTMENT OR OBLIGATED SERVICE AS APPROPRIATE, EXPIRED ON THE DATE BELOW, THEREFORE YOU ARE HEREBY
DISCHARGED FROM THE U.S. NAVY RESERVE AS OF MIDNIGHT OF THAT DATE.
2. YOU ARE
RECOMMENDED FOR REENLISTMENT. IF RECOMMENDED YOU MAY REENLIST AT THE NEAREST NAVY RESERVE
ACTIVITY. REENLISTMENT WITHIN 90 DAYS FROM YOUR DISCHARGE DATE WILL QUALIFY YOU FOR CONTINUOUS SERVICE.
DOCUMENTS REQUIRED FOR REENLISTMENT INCLUDES THIS FORM, YOUR HONORABLE DISCHARGE CERTIFICATE, DD FORM 256N, AND
YOUR REPORT OF SEPARATION FROM ACTIVE DUTY, DD FORM 214, IF YOU HAVE ANY ACTIVE MILITARY SERVICE.
3. YOUR PERMANENT PERSONNEL RECORD IS ON FILE AT THE NAVY PERSONNEL COMMAND (PERS 313C), 5720 INTEGRITY DRIVE,
MILLINGTON, TN 38055.
ANY WRITTEN INQUIRIES CONCERNING YOUR RECORDS SHOULD INCLUDE YOUR FULL NAME, SOCIAL
SECURITY NUMBER AND DATE OF DISCHARGE FOR IDENTIFICATION PURPOSES.
PRIVACY ACT STATEMENT
1. AUTHORITY:
Authority for requesting this information is contained in 10 United States Code, Chapter 11,
5 U.S.C. 552a(a)(7),,(b)(3) and (e)(4)(D).
2. PURPOSE:
To provide information for use in identifying individuals for issuance of discharge documents from the Naval Reserve.
3. ROUTINE USES: Information provided is used to identify the individual and his or her service record.
4. DISCLOSURE:
Disclosure is voluntary; however, failure to fully complete all portions of this form may affect timeliness of issuance of the
document.
DISCHARGE DATE
IMMEDIATELY REENLISTED
NAME (First, Middle, Last)
RATE
SOCIAL SECURITY NUMBER
BRANCH AND CLASS
NAVPERS 1070/615 RECORD OF DISCHARGE FROM THE U.S. NAVY RESERVE. (REV 08-06)
S/N: 0106-LF-133-2300
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