National Personnel Records Center
Military Personnel Records
9700 Page Avenue
St. Louis, MO 63132-5100

 

Date: ____________________________

 

 

Dear Sirs or Madams:

 

I am requesting, under the Federal Freedom of Information Act, the publicly-releasable form of the military record of;

 

 

Full Name:___________________________________________________________

 

SSAN/Service Number_________________________________________________

 

Date of Birth _________________________________________________________

 

Home Town/Place of Birth _____________________________________________

 

Branch of Service _____________________________________________________

 

Dates of Service _______________________________________________________

 

Place entered Service __________________________________________________

 

Last Unit of Assignment ________________________________________________

 

Place of Discharged____________________________________________________

 

Please Mail your findings to;

 

______________________________________________________

 

______________________________________________________

 

______________________________________________________

 

______________________________________________________

 

 

Signature: ____________________________________________________________