Form DD Form 565 DD Form 565 STATEMENT OF RECOGNITION OF DECEASED

CUI (when filled in)
OMB No. 0704-SROD
Expires YYYYMMDD

STATEMENT OF RECOGNITION OF DECEASED

The public reporting burden for this collection of information is estimated to average ## hours/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, at [email protected]. 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.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION.
1. BELIEVED TO BE (BTB) IDENTIFIED DECEDENT
a. NAME (Last, First, Middle Initial) (or Unidentified)

b. GRADE

e. ORGANIZATION

c. DoD ID NO.

d. DATE OF BIRTH (YYYYMMDD)

f. SERVICE

g. RECEIVED FROM

h. EVAC #

i. RFID #

j. CBRNE STATEMENT (X one)
YES

NO

2. I HAVE PERSONALLY VIEWED THE REMAINS BTB IDENTIFIED ABOVE. RECOGNITION IS BASED ON THE FOLLOWING:

NEEDS DD67
3. DETAILS OF VIEWING/BTB IDENTIFICATION
b. TIME
a. DATE (YYYYMMDD)

c. PLACE

4. PERSON MAKING VISUAL IDENTIFICATION
a. NAME (Last, First, Middle Initial)

b. GRADE

d. ORGANIZATION

e. SIGNATURE

c. DoD ID NO.

f. DATE SIGNED (YYYYMMDD)

g. AFFILIATION TO DECEASED

h. LENGTH OF TIME YOU KNEW DECEASED (Number of months, years, or N/A)

5. WITNESS
I certify that the individual identified in item 4 has viewed the remains in my presence, and that to the best of my knowledge the above information is true.
a. NAME (Last, First, Middle Initial)

d. ORGANIZATION

DD FORM 565, 20240626 DRAFT
PREVIOUS EDITION IS OBSOLETE.

b. GRADE

e. SIGNATURE

CUI (when filled in)

c. DoD ID NO.

f. DATE SIGNED (YYYYMMDD)

Controlled by: OUSD(P&R)
CUI Category: PRVCY
Distribution/Dissemination Control: FEDCON
POC: [email protected]

Page 1 of 1