TOM GREEN COUNTY CLERK’S OFFICE

TOM GREEN COUNTY CLERK'S OFFICE 124 W. BEAUREGARD

SAN ANGELO, TX 76903 REQUEST FOR CERTIFIED COPIES ? DD214 (MILITARY DISCHARGE) TODAY'S DATE:__________________ FULL NAME OF SERVICE MEMBER:________________________________________________________ SOCIAL SECURITY NUMBER: ______________________________________________________________ DATE OF SEPARATION:__________________________________________________________________ NAME OF PERSON REQUESTING RECORD:___________________________________________________ RELATIONSHIP TO VETERAN: _____________________________________________________________ ADDRESS:_____________________________________________________________________________ CITY, STATE, ZIP:_______________________________________________________________________ TELEPHONE NUMBER: __________________________________________________________________

I swear, under penalty of law, that the information given above is true and correct.

SIGNATURE OF APPLICANT (FIRMA)

DATE (FECHA)

THE STATE OF _________

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COUNTY OF __________

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BEFORE ME, the undersigned authority, on this day personally appeared ___________________________________________________________________________ Known to me to be the person whose name is subscribed on the foregoing instrument, and acknowledged to me that they executed the same for the purposes and consideration therein expressed.

GIVEN UNDER MY HAND AND SEAL OF OFFICE on this ________day of __________, ________.

Notary Signature____________________________ Printed Name of Notary______________________ My commission expires on ____________________

WE WILL NEED TO MAKE A COPY OF YOUR DRIVER'S LICENSE OR STATE ID

If the record was filed on or after September 1, 2003, the record is confidential for 75 years and only the persons listed in the following statute may obtain or view the DD 214.

Texas Government Code Sec. 552.140 (c) states "On request and the presentation of proper identification, the following persons may inspect the military discharge record or obtain from the governmental body free of charge a copy or certified copy of the record: (1) the veteran who is the subject of the record; (2) the legal guardian of the veteran; (3) the spouse or a child or parent of the veteran or, if there is no living spouse, child, or parent, the nearest living relative of the veteran; (4) the personal representative of the estate of the veteran; (5) the person named by the veteran, or by a person described by Subdivision (2), (3), or (4), in an appropriate power of attorney executed in accordance with Section 490, Chapter XII, Texas Probate Code; (6) another governmental body; or (7) an authorized representative of the funeral home that assists with the burial of the veteran."

In order to obtain a DD214 - applicant must provide a photo copy ID (Driver License, State Issued ID, etc.) DD214 are provided as certified copies at no charge to the applicant with proper 1D. For more information please call our office in the Vital Statistics Dept. 325-659-6556.

Complete the application, make a copy of valid ID and fax information to325-659-3251 or email information to vitalstatistics@co.tom-green.tx.us

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