Fillable Form DS109 : SEPARATION STATEMENT U S Department: Fill out & sign online

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Click ‘Get Form’ to open it in the editor.
Begin by entering your full name in the designated field at the top of the form. Ensure that you type or print clearly for legibility.
Proceed to section one, where you will confirm that you have surrendered all classified documents. Check the box indicating compliance and provide any necessary details if prompted.
In section two, confirm that all federal records have been incorporated into the official record keeping systems. This may involve checking additional boxes or providing specific information about your records.
Continue through sections three to eight, ensuring you read each statement carefully and check the appropriate boxes as applicable to your situation.
Finally, complete the signature fields at the bottom of the form, including both your signature and that of the interviewing officer, along with their typed names and dates.

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2020	4.9 Satisfied (56 Votes)

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