REQUEST PERTAINING TO MILITARY RECORDS (Enter data first, then print out form at 95%, then fax to Touchstone.) Please fill out as much information as possible. Service dates should be as close as possible. SECTION I SECTION II I would like an undeleted Report of Separation (DD214 or equivalent) An undeleted DD214 shows all information including my character of service, reason for separation etc. I would like a deleted Report of Separation. (DD214 or equivalent) This will not show authority for separation, reason for separation, reenlistment eligibility code, separation code, and for separations after June 30th 1979 it will not show character of separation. Other information and documents needed
Purpose for documents (optional)
SECTION III Requester is the military service member or veteran identified in Section I above. Next of kin of deceased veteran. Date of death of veteran. Relationship to veteran. Legal guardian (must submit copy of court appointment). Other (specify)
To the National Personnel Records Center and any other government agency in possession of any military records of the above named veteran.
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 full power 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 on this Section III is true and correct.
_____________________________________________________________ PRINT NAME SIGNATURE & DATE
For questions or guidance concerning this request, contact: the Touchtone researcher who submitted this request; OR
TO: TOUCHSTONE RESEARCH GROUP LLC FAX: 646-530-8701
Please fax both pages of this form. This will help us file your payment and records request together. Order Number (from your web order or order confirmation e-mail) Name of person whose records are being obtained
For speediest service, fax the form and your request to: 800-At-DD214 (800-283-3214) or 646-530-8767 (Our voice/fax system is seeking a fax tone for routing. You may have to push "send fax" when you connect.)
OR mail originals to us. Our mailing address is:
Touchstone Research Group, LLC
244 Fifth Avenue
2nd Floor, Suite 2571
New York, NY 10001-7604
MONEY ORDER? If paying by money order, include a fax copy and indicate the date you mailed your money order
CHECK? No need to send your check. If you’ve paid by eCheck, just fax a copy of your check marked “VOID” and it will be processed electronically.
WESTERN UNION? If you’ve paid by Western Union, the Money Transfer control number is
CREDIT CARD PAYPAL GOOGLE CHECKOUT
Date you faxed these documents
If you’ve faxed your documents to us, you can retain the originals for your records. Upon receipt of your FAX or originals, your order will be queued for processing.
DON'T FORGET TO SIGN THE REQUEST PAGE BEFORE FAXING IT TO US!