Form SSA-L707 Request for Proof(s) from Custodian of Records

• The following information may assist you in locating the correct record:
Death Record
Full Name of Deceased (first, middle, last) ----------------------Date of Death (month, day, year) --------------------------

Sex __________
Date of Birth (month, day,year)______State of Birth _____________
Place of Death (city, county if known, state) ---------------------• If unable to locate record, please indicate years searched___ and sign__________
Marriage Record
Name of Groom or Party 1 (first, middle, last)

Date of Birth (month, day, year)
---------------------·--------------------------Place of Birth--------------------------------Name of Bride or Party 2 (first, middle, last)---------------------Date of Birth (month, day, year) -------------------------PIace of Birth --------------------------------Date of Marriage (month, day, year)------------------------1 f date unknown, year(s) to be searched ----------------------County that issued license ---------------------------County and state where marriage occurred ---------------------• If unable to locate record, please indicate years searched ____and sign. _________
Divorce Record
Name of Spouse Husband or Party 1 (first, middle, last)
Date of Birth (month, day, year)

-----------------

--------------------------

Name of Spouse Wife or Party 2 (first, middle, last)

-----------------------

Date of Birth (month, day, year) :__________________________
--------------------------If date unknown, year(s) to be searched
-----------------------Date of Divorce (month, day, year)
County and state where divorce occurred----------------------• If unable to locate record, please indicate years searched ____and sign. _________

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Form SSA-L707 (06-2014) EF (06-2014)

See Revised
Privacy Act
Statement