Date: ________________
DD214 AUTHORIZATION
I hereby authorize the Officers and Board of Directors of the Viet Nam Veterans of Diablo Valley to maintain on file electronic and/or paper copies of my DD214 and, in the event of my death, to provide copies of said document to my next of kin, as necessary, to facilitate their acquisition of survivors and/or death benefits to which I/they may be entitled. This authorization shall remain in force for a period not to exceed five (5) years following my death unless rescinded by me prior to my death or my survivor(s) after my death.
I understand that during my lifetime I may acquire copies of my DD214 from the V.N.V.D.V for a small administrative fee to cover administrative/postage costs, such fee to be set by the Board of Directors and published to the membership as changes/adjustments may be necessary.
PRINTED NAME: _________________________________
Signature of Member:_____________________________________
Witness Printed Name:_______________________________________
Witness Signature:________________________________________________
P. O. BOX 2079 - DANVILLE, CA 94526 - 2079 - VOICE MAIL: 925 / 355 – 8051 - E-MAIL: - WEBSITE : www.VNVDV.com
Viet Nam Veterans of Diablo Valley is a non-profit veterans organization/corporation (EIN 68-0266369) exempt from federal (IRC 501a) and state (RTC 23701w) income tax