Your IP is: 3.226.248.180
EZDD214.com   |   Voice/Fax 800-283-3214   |   Form Expires 4/30/2021

Please wait while we process this form.

This may take up to one minute to complete.
Be sure "not" to refresh or leave this page....


We Need the Order ID

To quickly get started, please enter the Last Name & Email Address that was used in registering with ezDD214.com, so that we can pull the proper Order ID.

* If you are representing your client, please enter the Last Name and Email Address which is used in your ezDD214 account registration. The name on the form can be changed at any time beyond this point.

Registered Last Name:
Registered Email:

REQUEST PERTAINING TO MILITARY RECORDS

To ensure the best possible service, please thoroughly review the
accompanying instructions before filling out this form. Please print
clearly or type. If you need more space, use plain paper

SECTION I - INFORMATION NEEDED TO LOCATE RECORDS (Furnish as much as possible.)

1. NAME USED DURING SERVICE (last, first, and middle)

2. SOCIAL SECURITY NO.

3. DATE OF BIRTH

4. PLACE OF BIRTH

5. SERVICE , PAST AND PRESENT

(For an effective records search, it is important that all service be shown below.)
DATES OF SERVICE CHECK ONE SERVICE NUM. FOR THIS PERIOD
BRANCH OF SERVICE DATE ENTERED DATE RELEASED OFFICER ENLISTED (If unknown, write "unknown")
a. ACTIVE
SERVICE
b. RESERVE
SERVICE
c. NATIONAL
GUARD
6. IS THIS PERSON DECEASED? If "YES" enter the date of death.
7. IS (WAS) THIS PERSON RETIRED FROM MILITARY SERVICE?

SECTION II - INFORMATION AND/OR DOCUMENTS REQUESTED

1. CHECK THE ITEM(S) YOU WOULD LIKE TO REQUEST A COPY OF:
DD Form 214 or equivalent. This contains info normally needed to verify military service. A copy may be sent to the veteran, the deceased veteran's next of kin, or other persons or organizations if authorized in Section III, below. NOTE: If more than one DD214 Check the appropriate box below to specify a deleted or undeleted copy.
When was the DD Form(s)214 issued? YEAR(s):
UNDELETED: Ordinarily required to determine eligibility for benefits. Sensitive items, such as, the character of separation, autherity for separation, reason for separation, reenlistment eligibility code, separation (SPP/SPN) code, and dates of time lost are usually shown.
DELETED: The following items are deleted.authority for separation, reason for separation, reenlistment eligibility code,separation(SPD/SPN) code, and for separations after June 30, 1979, character of separation and dates of time lost.
All Documents in Official Military Personnel File (OMPF)
Medical records (Includes Service Treatment Records (outpatient), inpatient and dental records.) If hospitalized, provide facility name and
date for each admission:
Other (Specify):
2. PURPOSE ( An explanation of the purpose of the request is strictly voluntary, however, Such information may help to provide the best possible response and may result in a faster replay. Information provided will in no way be used to make a decision to deny the request.) Check appropriate box:

SECTION III - REQUESTER'S ADDRESS AND SIGNATURE

1. REQUESTER IS:
  Military service member or veteran identified in Section I, above
  Legal guardian (must submit copy of court appointment)
  Next of kin of deceased veteran (relation)
  Other (specify)
2. To the NPRC and any other government agency in possession of any of my military and/or medical records: I hereby grant Touchstone Research Group LLC and their researchers a Limited Power of Attorney for the sole purpose of obtaining my records, and to do and perform all and every act and thing whatsoever necessary to be done in and about the specific and limited premises(set out herein) as fully, to all, intents and purposes, as might or could be done if personally present, with fullpower of substitution and revocation, hereby ratifying and confirming all that said attorney shall lawfully do or cause to be done by virtue hereof.

I declare (or certify, verify, or state) under penalty of perjury under the laws of the United States of America that the information in this Section III is true and correct.

Date of this request Daytime phone   () Email address
For questions or guidance concerning this request, contact:

the Touchtone researcher who submitted this request;

OR: Touchstone Research Group LLC
Processing
4847 Navy Road
Unit# 1167
Millington TN 38083
800-AT-DD214 (800-283-3214)


FAX to: 646-530-8701
Order No.

Signature Options: What's the difference?
  

Signature     (Please do not print.)