Form SSA-L707 Request for Proof(s) from Custodian of Records

Form Approved

Social Security Administration
OMB No. xxxx-xxxx
REQUEST FOR PROOF(S) FROM CUSTODIAN OF RECORDS
Date: _________________________________

Unit Number: _________________________

Number Holder: __________________________
TO:

Custodian of Records

_________________________________
ADDRESS
_________________________________
_________________________________
►Please furnish a certified copy of your record or a Letter of No Record for the following event(s):

Death

Marriage

Divorce
See page 2 for details. Include this form with your response.
►Verification of Requester’s Identity (If required) – Proof of the requester’s identity is attached. 
►The document is needed for Social Security Administration purposes.
►Enclosed is $_______________ in the form of:

Personal Check

Certified Check

Money Order

Credit Card (Type, Number, Expiration Date, Name as shown on card)
________________________________________________________________________

Other (specify) ____________________________________________________

No Fee Required
Do not send cash.
►Please send the document(s) to (check one):
 The Social Security office

OR

 My address below.

(Please Print)
Social Security Administration
Attention:
_________________________
ADDRESS
_________________________

(Please Print)
________________________
NAME
________________________
ADDRESS
________________________

_________________________

________________________

 I authorize the disclosure of the requested information to the Social Security Administration.
NAME OF REQUESTOR

RELATIONSHIP TO PERSON ON
RECORD

Form SSA-L707 (00-2007) Destroy Prior Editions

SIGNATURE OF REQUESTOR

Page 1

►The following information may assist you in locating the correct record.
Death Record
Full Name of Deceased (first, middle, last) _________________________________
Date of Death (month, day, year)________________________________________
Sex ____________________________ State of Birth _________________________
Place of Death (city, county if known, state) ________________________________
► If unable to locate record, please indicate years searched and sign. ______________________________
Marriage Record
Name of Groom (first, middle, last) _______________________________________
Date of Birth (month, day, year) ___________________________________________
Place of Birth __________________________________________________________
Name of Bride (first, middle, last) _________________________________________
Date of Birth (month, day, year) ___________________________________________
Place of Birth __________________________________________________________
Date of Marriage (month, day, year) _______________________________________
If date unknown, year(s) to be searched ______________________________________
County that issued license __________________________________________________
County and state where marriage occurred ___________________________________________
 If checked, please include age or birth date of ______________________ as shown on marriage record.
► If unable to locate record, please indicate years searched and sign. _____________________________
Divorce Record
Name of Husband (first, middle, last) __________________________________________
Date of Birth _____________________________________________________________
Name of Wife (first, middle, maiden) __________________________________________
Date of Birth_____________________________________________________________
Date of Divorce (month, day, year) __________________________________________
If date unknown, years to be searched _________________________________________
County and state where divorce occurred ____________________________________________
►If unable to locate record, please indicate years searched and sign. _____________________________
Privacy Act – The Privacy Act requires us to notify you that we are authorized to collect this information
by section 205(a) of the Social Security Act. You do not have to provide the information requested. The
data you provide, however, will allow the Social Security Administration to determine the eligibility for
benefits of a person who is applying for Social Security or Supplemental Security Income benefits. If you
do not complete this form, that person may not be entitled to benefits. We do not disclose the information
you provide to any person or other government agency. We may also use the information you give us
when we match records by computer. Matching programs compare our records with those of other Federal,
State, or local government agencies. Many agencies may use matching programs to find or prove that a
person qualifies for benefits paid by the Federal government. The law allows us to do this even if you do
not agree to it. Explanations about these and other reasons why information you give us may be used or
given out are available in Social Security offices. If you want to learn more about this, contact any Social
Security office.
Paperwork Reduction Act Statement – This information collection meets the requirements of 44 U.S.C.
§ 3507, as amended by Section 2 of the Paperwork Reduction Act of 1995. You do not need to answer
these questions unless we display a valid Office of Management and Budget control number. We estimate
that it will take about 10 minutes to read the instructions, gather the facts, and answer the questions. SEND
OR BRING THE COMPLETED FORM TO YOUR LOCAL SOCIAL SECURITY OFFICE. The
office is listed under U. S. Government agencies in your telephone directory or you may call Social
Security at 1-800-772-1213 (TTY 1-800-325-0778). You may send comments on our time estimate above
to: SSA, 6401 Security Blvd, Baltimore, MD 21235-6401. Send only comments relating to our time
estimate to this address, not the completed form.
Form SSA-L707 (00-2007) Destroy Prior Editions

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