MVAA Forms

DD-214 Request Form

Instructions for completing the form

Before you get started, there are a few things you should know:

For most people, it will take 5 to 10 minutes to fill out the DD-214 Request Form.
The form will time out after 15 minutes of inactivity. You will get a two-minute warning before this happens. Any information that has not been saved will be lost.

Request on Veteran’s Behalf

Veteran Information

First Name

Last Name

Service/Social Security Number

Veteran Phone

Date Of Birth

Deceased

Branch of Service

Service Component

Period of Service

Purpose Of Request

Mail to Address

Street Address

Apt/Suite/Other

City

State

ZIP Code

Attachments

Power of Attorney

Browse

Death Certificate

Browse

Signature

I declare (or certify, verify, or state) under penalty of perjury under the laws of the United States that the information in this section is true and correct.

First Name

Last Name

Active Duty
National Guard
Reserve

Active Duty
National Guard
Reserve

WW II 12/7/1941-12/31/1946
Korea 6/27/1950-1/31/1955
Vietnam 2/28/1961-5/7/1975
Gulf War 8/2/1990-Present
Other

WW II 12/7/1941-12/31/1946
Korea 6/27/1950-1/31/1955
Vietnam 2/28/1961-5/7/1975
Gulf War 8/2/1990-Present
Other