If possible, include a copy of the discharge or separation document, WDAGO Form 53-55 or DD Form 214.Only the service member, guardian, or next of kin may sign this form. Record a return address and then sign section 3.In section 2, indicate which medals need to be replaced.Indicate whether or not the person retired from the military in section 1, block 7.Indicate whether or not the individual is deceased in section 1, block 6.Provide the dates of service in the applicable spaces in section 1, block 5. Fill in the individual's name, social security number, and date and place of birth in section 1, blocks 1 through 4.
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