DD Form 565 Statement of Recognition of Deceased

DD Form 565 - also known as the "Statement Of Recognition Of Deceased" - is a Military form issued and used by the United States Department of Defense.

The form - often incorrectly referred to as the DA form 565 - was last revised on August 1, 2015. Download an up-to-date fillable DD Form 565 down below in PDF-format or find it on the Department of Defense documentation website.

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STATEMENT OF RECOGNITION OF DECEASED
1. BELIEVED TO BE (BTB) IDENTIFIED DECEDENT
a. NAME (Last, First, Middle Initial) (or Unidentified)
b. GRADE
c. SSN/DoD ID NUMBER
d. DATE OF BIRTH (YYYYMMDD)
e. ORGANIZATION
f. SERVICE
g. RECEIVED FROM
h. EVAC #
i. RFID #
j. CBRNE STATEMENT (X)
YES
NO
2. I HAVE PERSONALLY VIEWED THE REMAINS BTB IDENTIFIED ABOVE. RECOGNITION IS BASED ON THE FOLLOWING:
3. DETAILS OF VIEWING/BTB IDENTIFICATION
a. DATE ( YYYYMMDD)
b. TIME
c. PLACE
4. PERSON MAKING VISUAL IDENTIFICATION
a. NAME (Last, First, Middle Initial)
b. GRADE
c. SSN/DoD ID NUMBER
f. DATE SIGNED
d. ORGANIZATION
e. SIGNATURE
(YYYYMMDD)
g. RELATIONSHIP TO DECEASED (CDR, ISG, Friend, Relative, Mortuary Affairs
h. LENGTH OF TIME YOU KNEW DECEASED (Number of months or years)
Personnel, etc.)
(Mortuary Affairs Personnel mark this block N/A)
5. WITNESS
I certify that the individual identified in Item 4 has viewed the remains in my presence, and that to the best of my knowledge the above information
is true.
a. NAME
b. GRADE
c. DoD ID NUMBER
f. DATE SIGNED
d. ORGANIZATION
e. SIGNATURE
DD FORM 565, AUG 2015
PREVIOUS EDITION IS OBSOLETE.
Adobe Professional X
STATEMENT OF RECOGNITION OF DECEASED
1. BELIEVED TO BE (BTB) IDENTIFIED DECEDENT
a. NAME (Last, First, Middle Initial) (or Unidentified)
b. GRADE
c. SSN/DoD ID NUMBER
d. DATE OF BIRTH (YYYYMMDD)
e. ORGANIZATION
f. SERVICE
g. RECEIVED FROM
h. EVAC #
i. RFID #
j. CBRNE STATEMENT (X)
YES
NO
2. I HAVE PERSONALLY VIEWED THE REMAINS BTB IDENTIFIED ABOVE. RECOGNITION IS BASED ON THE FOLLOWING:
3. DETAILS OF VIEWING/BTB IDENTIFICATION
a. DATE ( YYYYMMDD)
b. TIME
c. PLACE
4. PERSON MAKING VISUAL IDENTIFICATION
a. NAME (Last, First, Middle Initial)
b. GRADE
c. SSN/DoD ID NUMBER
f. DATE SIGNED
d. ORGANIZATION
e. SIGNATURE
(YYYYMMDD)
g. RELATIONSHIP TO DECEASED (CDR, ISG, Friend, Relative, Mortuary Affairs
h. LENGTH OF TIME YOU KNEW DECEASED (Number of months or years)
Personnel, etc.)
(Mortuary Affairs Personnel mark this block N/A)
5. WITNESS
I certify that the individual identified in Item 4 has viewed the remains in my presence, and that to the best of my knowledge the above information
is true.
a. NAME
b. GRADE
c. DoD ID NUMBER
f. DATE SIGNED
d. ORGANIZATION
e. SIGNATURE
DD FORM 565, AUG 2015
PREVIOUS EDITION IS OBSOLETE.
Adobe Professional X

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