SF 180 Request Pertaining to Military Records

Standard Form 180 (Rev. 09/08) (Page 1) Authorized for local reproduction

Prescribed by NARA (36 CFR 1228.168(b)) Previous edition unusable OMB No. 3095-0029 Expires 10/31/2011

REQUEST PERTAINING TO MILITARY RECORDS

* Requests from veterans or deceased veteran’s next-of-kin may be submitted online by using eVetRecs at http://www.archives.gov/veterans/evetrecs/ *

(To ensure the best possible service, please thoroughly review the accompanying instructions before filling out this form. Please print clearly or type.)

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.)

BRANCH OF SERVICE

DATE ENTERED

DATE RELEASED

OFFICER

ENLISTED

SERVICE NUMBER (If unknown, write “unknown”)

a. ACTIVE COMPONENT

b. RESERVE COMPONENT

c. NATIONAL GUARD

6. IS THIS PERSON DECEASED? If “YES” enter the date of death.

7. IS (WAS) THIS PERSON RETIRED FROM MILITARY SERVICE?

NO YES

NO YES

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 form contains information 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 period of service was performed, even in the same branch, there may be 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, authority for separation, reason for separation, reenlistment eligibility code, separation (SPD/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, the facility name and date for each admission must be provided:

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 reply. Information provided will in no way be used to make a decision to deny the request.) Check appropriate box:

Benefits

Employment

VA Loan Programs

Medical

Medals/Awards

Genealogy

Correction

Personal

Other, explain:

SECTION III - RETURN ADDRESS AND SIGNATURE

1. REQUESTER IS: (Signature Required in # 3 below of veteran, next of kin, legal guardian, authorized government agent or ”other” authorized representative. If “other” authorized representative, provide copy of authorization letter.)

Military service member or veteran identified in Section I, above

Legal guardian (Must submit copy of court appointment.)

Next of kin of deceased veteran

(Must provide proof of death).

Other (specify)

Show relationship:

(See item 2a on accompanying instructions.)

3. AUTHORIZATION SIGNATURE REQUIRED (See items 2a or 3a on accompanying instructions.) 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.

2. SEND INFORMATION/DOCUMENTS TO: (Please print or type. See item 4 on accompanying instructions.)

Name

Signature Required - Do not print

( )

Street Apt.

Date of this request Daytime phone

City State Zip Code

Email address

*This form is available at http://www.archives.gov/research/order/standard-form-180.pdf on the National Archives and Records Administration (NARA) web site.*