REQUEST FOR REMOVAL OF MILITARY DISCHARGE OR REDACTION OF SOCIAL SECURITY NUMBER FROM A MILITARY DISCHARGE
1. Full Name of Veteran:
2. Name of Person Making Request:
3. If not the Veteran making the request, identify the legal relationship that entitles the Person Making Request to make the request: (check one)
4. Check (a) or (b):
5. Type of Military Discharge Record:
6. Book and Page Number or other reference identifying where the military discharge record is recorded in the County Register's office:
Book No. Page No. ; or
No.
7. Signature of Person Making Request:
State of Tennessee
County of
Personally appeared before me __________, (person duly authorized to take acknowledgments in county), the within named , with whom I am personally acquainted (or proven to me on the basis of satisfactory evidence) and who acknowledges that such person executed the within instrument for the purpose of making a request of the Register of Deeds of County, Tennessee, to remove a military discharge record or redact a social security identification number from a military discharge record, excepting microfilm records.
Witness my hand this day of , 20 .
(signature of person taking acknowledgement)
[Space for Seal of Office]
Spouse, child, or parent (or nearest living relative if there is no living spouse, child, or parent) of the veteran
Attorney-in-fact
Personal Representative of Veteran's Estate
Legal Guardian
Request removal of military discharge record
Request redaction of social security number on military discharge record (if practicable)