CIVILIAN PERSONNEL RECORDS

SECTION III
  Requester is the employee identified in Section I  above. 
  Next of kin of deceased employee.   Date of death of employee.  Relationship to employee.   
  Legal guardian (must submit copy of court appointment).             Other (specify)     

To the National Personnel Records Center and any other government agency in possession of any military records of the above named veteran.

I allow the bearer of this authorization____________to be filled out by the researcher________________________to act as my representative for the 
purpose of  obtaining my records. I allow the National Personnel Records Center or any other Government Agency with information concerning 
my records  to convey  by voice, fax, email or postal  mail the following:  all of my records; part of my records; or any  information that may be 
used to obtain my record to my representative including mailing or faxing them.   I am aware fax and or email attachments are not secure
 transmissions, and that there is chance that others may be able to view my records during transmission

I declare (or certify, verify, or state) under penalty of perjury under the laws of the United States of America that " the information on this
Section III is true and correct.

________________________________________________________ ___________________________________________________________________
                       PRINT NAME  above                                                       SIGNATURE &  DATE  above

                 DAY PHONE  NIGHT PHONE                               
Street Address                                                                                                                                                                                  
            
Address                                                                                                                                              EMAIL ADDRESS
                      
CITY                                                                                                                                                       STATE                                              ZIP CODE                  
FAX TO 314 754-9690

             PLEASE YOU THIS PAGE AS YOUR COVER SHEET.

FROM:_____________________________________________FAX #____________________________

TO:        LYON RESEARCH                      FAX 314 754-9690

Please fax both pages of this form.  This will help us file your payment and records request together.
Name of person whose records are being obtained

Comments____________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________
We only take credit cards online.  Please do not write your credit card information on this page, we will not be able to process it.   If you do not want to pay with a credit card on line, you may sent a check. Sending a check will not delay the process if you send the check in the mail and fax this form, we will obtain your record by the time your check arrives.
Select the service you are requesting and payment method.
 Leaving this section blank will cau

We Only Process Credit Cards Online  NO PHONE ORDERS sf form 50 retrieval   Credit Card Check PRIORITY form 50 $89.00

se delays in obtaining your record. 

You can fax the form and mail a check or mail both. We only process credit cards online.  We cannot process them over the phone or by mail. Our mailing address is: Lyon Research Box 645 Dunn Loring, VA 22027-0645 1(703) 560-3922 1(314)754-9690 fax

Did you fax the record to us?    YES   NO    If yes what date_______________.

Office Use Only Below This Point