Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Authorization for Veterans Disability Record

  1. Applicant must complete section I, forward to regional office of veteran's administration where disability claim is now on file.
    I hereby authorize you to furnish the Yates County Personnel Office with my medical and disability record. You are released from all liability in complying with this request. It is understood that all information furnished will be treated as confidential.
  2. By typing your name into this field you authorize Yates County to consider this an electronic signature.
  3. Exam Number and Title
  4. Leave This Blank:

  5. This field is not part of the form submission.