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Get Discharge Form From Military

PRIVACY ACT RELEASE FORM Veterans/Active Duty Military Casework This form must be completed by the veteran /service member Federal agencies are prohibited from releasing information concerning an individual to a third party under the Privacy Act of 1974. Please complete and sign this form which will allow information regarding your concern to be released to the office of Senator Barbara A. Mikulski. Name of Veteran/Service Member Date of birth VA Claim Number Social Security Number MD Residential Street Address If you use a PO Box you must also provide a MD address of record Phone number s Have you contacted another congressional office about this case If yes which office NATURE OF PROBLEM/ASSISTANCE REQUESTED BRANCH OF SERVICE ENTRY DISCHARGE DATES - Signature Mail of Fax to Senator Barbara A. PRIVACY ACT RELEASE FORM Veterans/Active Duty Military Casework This form must be completed by the veteran /service member Federal agencies are prohibited from releasing information concerning an individual to a third party under the Privacy Act of 1974. Please complete and sign this form which will allow information regarding your concern to be released to the office of Senator Barbara A. Mikulski. Name of Veteran/Service Member Date of birth VA Claim Number Social Security Number MD Residential Street Address If you use a PO Box you must also provide a MD address of record Phone number s Have you contacted another congressional office about this case If yes which office NATURE OF PROBLEM/ASSISTANCE REQUESTED BRANCH OF SERVICE ENTRY DISCHARGE DATES - Signature Mail of Fax to Senator Barbara A. Mikulski 60 West St Suite 202 Annapolis MD 21401 Fax 410-263-5949 Additional comments or information may be attached Date. PRIVACY ACT RELEASE FORM Veterans/Active Duty Military Casework This form must be completed by the veteran /service member Federal agencies are prohibited from releasing information concerning an individual to a third party under the Privacy Act of 1974. Please complete and sign this form which will allow information regarding your concern to be released to the office of Senator Barbara A. Please complete and sign this form which will allow information regarding your concern to be released to the office of Senator Barbara A. Mikulski. Name of Veteran/Service Member Date of birth VA Claim Number Social Security Number MD Residential Street Address If you use a PO Box you must also provide a MD address of record Phone number s Have you contacted another congressional office about this case If yes which office NATURE OF PROBLEM/ASSISTANCE REQUESTED BRANCH OF SERVICE ENTRY DISCHARGE DATES - Signature Mail of Fax to Senator Barbara A. Mikulski. Name of Veteran/Service Member Date of birth VA Claim Number Social Security Number MD Residential Street Address If you use a PO Box you must also provide a MD address of record Phone number s Have you contacted another congressional office about this case If yes which office NATURE OF PROBLEM/ASSISTANCE REQUESTED BRANCH OF SERVICE ENTRY DISCHARGE DATES - Signature Mail of Fax to Senator Barbara A. Mikulski 60 West St Suite 202 Annapolis MD 21401 Fax 410-263-5949 Additional comments or information may be attached Date. .

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