REQUEST PERTAINING TO MILITARY RECORDS (Enter data first, then print out form at 95%, then fax to Touchstone.)
    Please fill out as much information as possible.      Service dates should be as close as possible.
     SECTION I  
     NAME USED DURING SERVICE 
     SOCIAL SECURITY NO.       
     DATE OF BIRTH
    PLACE OF BIRTH
    City State and Country


    LAST 

    FIRST

    MIDDLE 

     
    MO
    DAY
    YEAR
    DATES OF SERVICE
    CHECK ONE
    ACTIVE 
    SERVICE
    BRANCH OF SERVICE
    DATE ENTERED
    mm/dd/yr
    DATE RELEASED
    mm/dd/yr
    OFFICER
    ENLISTED
    Service # During Period
    RESERVE
    & IRR
    SERVICE
    NATIONAL
     GUARD
     
    SECTION II
       I would like an undeleted Report of Separation (DD214 or equivalent)
              An undeleted DD214 shows all information including my character of service, reason for separation etc.
       I would like a deleted Report of Separation.  (DD214 or equivalent)      This will not show authority for separation, reason for separation, reenlistment 
              eligibility code, separation code, and for separations after June 30th 1979 it will not show character of separation.
    Other information and documents needed     
    Purpose for documents (optional)
    
SECTION III
      Requester is the military service member or veteran identified in Section I  above. 
      Next of kin of deceased veteran.   Date of death of veteran.  Relationship to veteran.   
      Legal guardian (must submit copy of court appointment).             Other (specify)     

    To the National Personnel Records Center and any other government agency in possession of any military records of the above named veteran.

    I hereby grant Touchstone Research Group LLC and their researchers a Limited Power of Attorney for the sole purpose of obtaining my
    records, and to do and perform all and every act and thing whatsoever necessary to be done in and about the specific and limited premises (set out
    herein) as fully, to all intents and purposes, as might or could be done if personally present, with full power of substitution and revocation, hereby
    ratifying and confirming all that said attorney shall lawfully do or cause to be done by virtue hereof.
    I declare (or certify, verify, or state) under penalty of  perjury under the laws of the United States of America that the information on this 
    Section III is true and correct.

                      _____________________________________________________________    
    PRINT NAME                                                                                        SIGNATURE  &   DATE

    

    
              
    E-MAIL ADDRESS 
                                                                               DAYTIME PHONE

    

    For questions or guidance concerning this request, contact:
     the Touchtone researcher who submitted this request; OR

    

     

    Page 1

    PLEASE USE THIS PAGE AS YOUR COVER SHEET
    .

    FROM:              FAX #  


    TO:        TOUCHSTONE RESEARCH GROUP LLC                  FAX:   646-530-8701


    Please fax both pages of this form.  This will help us file your payment and records request together.
    Order Number (from your web order or order confirmation e-mail)
    Name of person whose records are being obtained

    Comments


    For speediest service, fax the form and your request to: 800-At-DD214 (800-283-3214) or 646-530-8767
    (Our voice/fax system is seeking a fax tone for routing. You may have to push "send fax" when you connect.)

    OR mail originals to us. Our mailing address is:

    Touchstone Research Group, LLC
    244 Fifth Avenue
    2nd Floor, Suite 2571
    New York, NY 10001-7604

    PAYMENT METHOD

    MONEY ORDER? If paying by money order, include a fax copy and indicate the date you mailed your money order

    CHECK? No need to send your check. If you’ve paid by eCheck, just fax a copy of your check marked “VOID” and it will be processed electronically.

    WESTERN UNION? If you’ve paid by Western Union, the Money Transfer control number is

    CREDIT CARD PAYPAL GOOGLE CHECKOUT

    Date you faxed these documents

    If you’ve faxed your documents to us, you can retain the originals for your records. Upon receipt of your FAX or originals, your order will be queued for processing.

    DON'T FORGET TO SIGN THE REQUEST PAGE BEFORE FAXING IT TO US!