DD Form X712 Vietnam War Commemoration Certificate of Honor: Former V

OMB No. 0704-0500
OMB approval expires

Vietnam War 50th Commemoration Certificate of Honor: Former Vietnam War POW
(The Former POW certificate is for former, living American military POWs from the Vietnam War as listed by the Department of Defense.)

The public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other
aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, Executive Services Directorate, Directives Division, 4800 Mark Center Drive, Alexandria, VA 22350-3100 (0704-0500). Respondents should be aware that notwithstanding any other provision of law,
no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. 3/($6('21275(7851<285)250727+($%29(25*$1,=$7,215(7851&203/(7(')250727+((0$,/$''5(66%(/2:

1.a. NAME AND ADDRESS TO SHIP CERTIFICATE FOR PRESENTATION
(FedEx does not deliver to P.O. Boxes)
Example: Mr. J.Q. Smith, 123 Main Street Apt #, City, State, ZIP
Name:

Street:

City:

State:

Name:

Street:

City:

State:

Name:

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City:

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Name:

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Name:

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Name:

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4.a. REQUESTED BY

DD FORM X712, 20160301 DRAFT

b. SHIPPING
TELEPHONE NO.
(For FedEx)

2.a. VETERAN'S
BRANCH OF
SERVICE

b. MILITARY
RETIREMENT
(Y/N)

898-123-4567

USMC

Yes

c. RANK AT TIME OF
RETIREMENT (*Including
Medical Retirement)
Colonel

3.a. RECIPIENT'S FIRST
NAME

b. RECIPIENT'S LAST
NAME

Michael

Smith

ZIP:

ZIP:

ZIP:

N E E D S

b. TELEPHONE NUMBER

ZIP:

D D

6 7

ZIP:

ZIP:

ZIP:

ZIP:

ZIP:

ZIP:

c. ORGANIZATION

d. EVENT DATE

*Requests should be emailed 60 days prior to presentation to:
[email protected]

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