REQUEST FOR REMOVAL OF MILITARY DISCHARGE OR REDACTION OF SOCIAL SECURITY NUMBER FROM A MILITARY DISCHARGE
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Book No. ______________ Page No. ______________; or
______________ No. ______________
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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]
T.C.A. § 10-7-513