REMOVAL OF MILITARY DISCHARGE Per Chapter 119, Florida Statutes, request for removal must be made in person. This is to certify that my name, address and phone number is: Time Stamp Here ____________________________ ____________________________ ____________________________ Phone ____________________________ I am the Veteran Widow/Widower Other__________________________ Veteran's Attorney, legal Guardian, personal representative, executor (Documentation presented :______________________________) I have recorded my discharge from the United States Armed Forces and it appears in your records in Official Records Book _____ Page _____ in Public Records of Brevard County. I request the removal of my discharge and I am aware that the removal is permanent. I understand that confirmation of the removal will be mailed to the address shown above. ___________________________________ Signature of Veteran (or person applying) Type of identification presented: Driver’s License Other ____________________ Clerk's Use Only Intake Clerk: __________________________ Redacting Clerk:___________________________ Date Confirmation mailed ________________