Military Discharge Papers Request Form

REOUEST REJECTION NO.: _______________ REOUEST VERIFICATION NO.: ___________________
REASON: _______________________________ RECORD LOCATION: ____________________________
DATE: _________________________________ DATE: _________________________________________
________________________________________________
RECORDER OF DEEDS
____________________________COUNTY, MISSOURI
(Reserved for Recorder's Information)

REQUEST FOR MILITARY DISCHARGE PAPERS
Approved by the Recorders Association of Missouri
Each Request Form is limited to one record.
1. Record Locator Information:

Veteran: ____________________________________________ _______________________________ _______
Last First MI
Filed in: ______________________________ County, Missouri
*Date of Birth: _________________________ *Branch and Date(s) of Service:
*SSN: ________________________________ _______________________________________
(*Complete one of the options)

2. Type and number of copies requested:

Number _____ Certified Copies Number _____ Uncertified Copies

3. Authorized Party requesting copy:

Name: _____________________________________________ _______________________________ _______
Last First MI
Street Address: __________________________________________________________________________________
City, State, Zip: ___________________________________________________________________________________
Telephone Number: _______________________________________________________________________________

4, Authorized Statement:
I certify that I am the authorized party pursuant to RSMo 59.480 as stated herein and request the following of the
above named veteran’s record:
1) ________Military Discharge Paper or ____________ Filed Request Form
2) Authorization Type: a) ________ Veteran named above; or
b) ________ Agent/representative of veteran (Mark appropriate category)
_____ Relative (Please state relationship)
_________________________________________________________________
_____ Attorney or Attorney in Fact
_____ Government Agency or Court (Please state)
_________________________________________________________________
_____ Funeral Director
_____ Other (Please state) ________________________________________________
_________________________________________________________________

Date: ____________________ _________________________________________________________________
Signature of Authorized Party
(Continued on Page 2)

RAM59.480/Rev.82803
 Missouri Request Form RAM59.480 Page 2

5. Notary Certificate
State of Missouri

County of ____________________

On this _____ day of _______________, in the year 20___, before me a Notary Public in and for the said

State, personally appeared ______________________________________________________________________________________
known to me to be the person(s) who executed the within Request for Military Discharge Papers and acknowledged they
executed the same for the purposes stated pursuant to RSMo. 59,480.

My Commission expires: _______________

________________________________________________________
Notary Public Signature
(Seal)

Request forms are not public records under RSMo 59.480. Completed request forms will be maintained in the
Recorder of Deeds for a period of five years from date of request and provided pursuant to RSMo 59.480.

INSTRUCTIONS FOR COMPLETING MISSOURI REQUEST FORM RAM59.480
All information must be typed or clearly printed black or dark ink in order to be accepted and filed. The requester shall
complete the following information in accordance with the rules and regulations stated.

Section t. Record Locator Information.
a. The name of the Veteran and the county that the Military Discharge Paper is filed in must he completed,
b. At least one of the following options must be provided in order to identify the requested record:
 Date of birth
 Social Security Number; or
 Branch and Date(s) of Service
Section 2. Type and number of copies requested. Each request form is limited to one Military Discharge Record. Requester must state the number of
each type of copy of the record to be requested. The Recorder of Deeds shall determine the maximum number of copies allowed per each request.
Section 3. Authorized Party requesting copy. The name, complete mailing address and the telephone number of the party authorized to make the
request must be completed.
Section 4. Authorized Statement. The requestor must complete I) Type of request being made and 2) Type of authority granted by statute either a) or
b). The requestor must date and sign as the Authorized Party in the presence of a Notary Public. The Recorder of Deeds may request proof of identify
and any additional documentation to verify the requestor’s statutory capacity.
Section S. Notary Certificate. The notary shall complete the notary clause in accordance with state laws. This shall include, but not be limited to an
original signature and their seal if applicable.

Recorder of Deeds Verification or Rejection.
1. The Recorder of Deeds shall complete the Request Verification of the Military Discharge Record Request by:
a. Assigning a Request Verification Number
b. Stating the location of the record provided (I.e. book and page, index number, etc.)
c. Provide the date the request was completed and filed.
d. Sign or initial the Verification.
e. Recorder shall maintain and file the original request form.
2. If a Request for Military Discharge Paper is incomplete or inaccurate, the Recorder of Deeds may reject the request by:
a. Assigning a Request Rejection Number
b. Stating the reason under the Request Rejection
c. Provide the date the request was rejected
d. Sign or initial the Rejection.
e. Recorder shall keep a copy of the rejected request form and return the original to the requester,
3. The Recorder of Deeds shall maintain an index separate from the public for all Verifications and Rejections.
4. The Recorder of Deeds shall keep and file all Verifications and Rejections fora period of five years from the date of the request. The Request
Forms are not public records and only provided pursuant to RSMo 59.480.