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Ohiodept of Health Hea5124 Form 2018-2023
Veteran, or the spouse or surviving spouse of a service member or veteran?
□ Yes □ No
If “Yes”
□ Military
□ Veteran
□ Spouse or Surviving Spouse of a Service Member or Veteran
Submit one of the following documents as proof of service:
Department of Defense identification card (Active, Retired, temporary disability retirement list (TDRL)
□
□ DD214 military discharge certificate indicating disposition of discharge
□ Report of separation from the national archives national personnel records...
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