National Personnel Records Center (MPR)
9700 Page Avenue
St. Louis, Missouri 63132
Dear National Personnel Records Center (MPR),
I hereby authorize the National Personnel Records Center, or other
custodian of my military service record, to release to ...
CITY, STATE, ZIP CODE
... the following information and/or copies of documents from my
military service record.
SPECIFY THE INFORMATION AND/OR DOCUMENT(s) REQUESTED
City, State, Zip Code
Phone number (optional)
Branch of service
Date of birth
Social Security Number
Dates of service (from MM/YY to MM/YY)