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: ____________________________________________________________