DEPARTMENT OF THE ARMY
Department of the Army
Seventh Brigade, US army cadet command
university of louisville
dougherty hall room 214
2301 south Third street
louisville, kentucky 40292
reply to
attention of:
atCC-GGk-YUL Date:
MEMORANDUM FOR Professor of Military Science
SUBJECT: Statement of Acknowledgement for Civilian Dental Records
_______ I have verified with my dentist that my dental records do contain descriptive profiles,
bite wing x-rays, orthodontic profiles or dental x-rays for identification purposes.
Dentist Name: ____________________________________ Phone: ______________________
Address: _________________________________________
_________________________________________
_________________________________ ________________________________
(CADET PRINT NAME) (CADET SIGNATURE)
_________________________________
(DATE)
................
................
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