REQUEST FOR DD-214 OR MILITARY RECORD 

Effective July 1, 2004, the Kansas Open Records Act exempts Military Discharge (DD-214) Records, amending K.S.A., 2003 Supp. 25-221, adding Exemption No. 47 (among others).  Access to said records is now restricted to the dischargee or his/her descendants or agents. 

To obtain a copy, check the appropriate line, sign and date on the lines provided.  WE WILL REQUIRE PHOTO ID. 

____  I am the Dischargee shown on the DD-214. 

____  I am the Dischargee’s immediate family member.

         (State relationship)________________________ (Wife, husband, widow/widower (not re-    married), son, daughter, father, mother, brother, sister or other lineal descendant (state type). 

____  I am the Dischargee’s heir, agent or assignee

         (State specific type).  ______________________

____  I am a licensed funeral director who has custody of the body of the deceased Dischargee.

                 License No. _________________

____  I represent a department or agency of the federal or state government or a political subdivision thereof; when the form is required to perfect the claim of military service or honorable discharge or a claim of a dependent.

                     Agency _____________________  Your Title _______________________

____  I have written approval of the commissioner of veteran’s affairs to perform research.  (Copy of said approval will be attached to this form.) 

Name _______________________________________________          Date ______________________ 

Address: _________________________________________________________________________________ 

Phone _______________________  Type of ID __________________________________________ 

Signature ______________________________________________________________________ 

Dischargee’s Name ______________________________________________________________ 

Register of Deeds or Deputy _______________________________________________________