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1. LAST NAME - FIRST NAME • MIO~LE NAME . Z. SERVIGE NUMBER ]adRAD[.RATEORRAN ~.r~T~ OF RMlK Ww. W~
14 2 21 P4 -4 P 3 0 un 62
S PHEN OAY MONTH YEAR
4. OEPART1AEIiT. COMPONEtiY IWD S. P~AC[ OR BIRTH (C~M ~ SrA Cw~d
Q BRANCH OR CU?SS e R`Ta 4 Se 42
htabula hio
w Sp~ c COLOR NAIR ?iOLOR EYES w HEIGHT WEIGHT S. 11.5. GIT12 9. MAIi1TAL STATIJS
RACB Ya Sin le X
Caucasian t~cle B am B own 6' 3" 180
w -.f;
° lOa HKiHEST CMlU1N EOUCATION lEVE1. ~OR C~~~ ~~E~
ATTAWEO -
1 Semester Jr. Colle e. Buildi w sCo
oNt~ ~AWT10N AT WHICM EFFEGTED
11a TYPE OF TRANSFER OR OISCMAR(iE ,
~ TRApg TO 11SAlt See 18 Fort Bustia Vir iaia ~Y ~,~,,,TM r~
« W c REASON AND AUTHORITY EFiEG- L :
u~ OA
E i l J~ v~ .
Z~ AR 635-200 SPN 201 8 iration ~Tet'6?~o ~ e cej~ -~~T SERVIGE ~V~F CERTIFICATE
~ 12. LILST WTY I~SSIGNMENT AN~ MAl j~'~?'~S A~~/
~ y:
Co B 69th Si Bn A t 8uatia Va ~ ' flONORABLS None .
z • S.,SELECTIYE SERVIGE LOCAL BOARD_NUMBER. G(7Y. COUNTY AN .STATE t6. DATE INOUGTED ,4•.
11. SELECTIVE SERV~C_ NUMBER ~ ~y~ . , . - ~ l p,AY MONTH YEAR
' ' ' ~ ` -l f `3 \ NA ,
WQ~ 8 40 42 ~ L8~ 0~ Pi r e Flo d ~
y~° 17. OISTRICT OR AR GOMMAND TO Wp~CM RESCRN~$T SF,ERR~D) ~ C-y ~
/ ~ ~ ~V ~
TRANS Zb U ~CONTROI+.GR~OR~ ~lSII~F IV OS ~S c'~: ~ pATE OR ENTRY
1e. 1 L . i9: GURREN TIVE SE CE THER T1~AN Y IN ~ Y RVIGE ~
RESEwvE O w : a 9CKJ~G .OF E~TRY K~ ~ DAY, + MONTH YEAR Y.
DAY MONrF1 Y SJE~4~`~rOf`~ E~tNW~ Ql tE0( r1s? ~~rN~ 3 \ 12 .TBA Vl
~ 11 Jan ~ 67.~ Q~ R: \
~R a~tE Oa ~~?T M of OF RENT rn/E gERViCC (cw S~wl ,
Zd. ~R10~ RE6 IAIt EMKiYENTi 2 q
r~ E' $CT B-1R~~,~.\ s~RwcE g orids~?~~ ~ .
' None • ~ . ;
. ~ 23. uOMEl/ Lll' O, ~~~t F ENYRY INTOIACTIVE SERVIGE Z~. STA OF SERV ~ 7EAR5 MOt~THS DAYS _ ~'r
bof S~` ~'i \ ~ ~*_~~e r!~.r~ewo ~ 1
~ _ - as~~t ,~a~:ou±~-sei~vtc~.~. - ; ,
Ft P~erce (S Lucie)~ `Florid~. ~~Y - -
25 a'SPECMLTY HVM~ER ANO ' i. R[u?TE~ C1wt.~AN C PA .".~lr09fi ~ t3~ TOUI W~»~!t fw W) ti 3 0 ~
~t~lp,Q,j~ Nu~.e~e- ~ s : 3 0 0
~ ~ ~ V~b~ 3V , / ' ~ A TO~AI: ACT11fE SERVICE ~ t
~ 293.Y~ ; ; , 1 . ~ . R SEA SERVICE . : 2 1 0
o RadRel~Carr ~Opes~. ! ltadio Opera~o~f ~ 4 Fo~° x•:
u 26. DECORATIONS. MEDA E5. GOMMEN T10NS~ ~TA AND CAMPAIGN R~BBONS AWARDED OR AUTHORRED , ' 1
~ :f
~ , , ~ ~ i . ~ r
~ Expext (Rifle) • ; ' ~ Sharpshooter~ (Rifle M-14) ; . • ~
N Sharpshooter (Carbine) Letter of`Appreciation Good ConducC Medal 1st;Award a-~y
27_ WOUNDS RECEIVED ILS A RESULT OF ACT~ON WITH ENEMY FORCES (No~ a~d d~l~? r b~"~) f; : t ~
\ . . : _ ~ ~ •
None ~ ' .1 ` ~ ~ ~ , ~ _ i I . • 29. OTMER SERVICE TRAWING
I ti. SERMCf SCNOOIS OR COtlE6ES, C LECE iR~~ ~Wa~ ~~0! /OSl•6RADUAiE CWRSES SUCEES~NLIr COYtlElEO- ` ~pup5E5 SUGCESSFULLY
SGNOOL OR COURSE . DATES fhoa•to? MAIOR COURSES ~ COMPIETEO
. • ? i" ~ ~ . .
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t ` ~ ' ' . l.~ . '
. ~ ` , - ~ ~ " ' ~ one
USASTIt Ft~Gordon; Ga `lAprbl . LIun61 li8d-16sL ~Carr/~per : ; ~ N :
' ~ . ~ l = 1_ ~ _ f~/ ~ T_"
. \ - . ~
' ~ ~ _ ` . : J.- • ` n MONTH ALLOTMENT s~~.
30a GOVERNMENT UFE INSUR/WCE IN FJRGE - AMOUNT OF ALLATMi~JT ' a ~NUED
` ? ~ ~ ° ~ ~ \ VA CLAIM NUMBER -
~ ]t a VA BENEFITS PREVIOUSLY APPtaED FOR I~I MMl -
' None - ~ . . . - . j C• PiA
32. REMARKS ~ - _ _
B'I.OOD GROUP: ~~A~~ _
~ SSAN: 267 -62-3657
o ITSM 3b: Date of appointment 30 Jun 63
~ Excess leave of 6 days frvm 27 Dec 63 - 1 Jan 64
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t ~3. rERM/wENT ADORE55 fOR MIULWG M!R?OS~ AFTER TRAMSFER ON 34. [ OF PER.r~ BEING TRIW ED ,O~R OISCHARG
pISCMARGE (Sf~ ~O. Ch. ~wW ~ s~l ~ K,~ 1ii~
601 S 17th St, Ft Pierce (St Lucie Fla ~RE N
3S a TYPE~ PIAMIE. GRADE AND TITLE OF AIJTHORIZ~ ~FlGER
RAY H, 1tA(~EL,S ,CAP'r TC TRANSFEA OFFICER
~RM 4_` ~ o~TLr ~ iu~ sa. ARMED FORCES OF THE N STA S q
r,, j,.Npy sEs . REPORT OF iRANSFER OR D GHARGE e(I; K . V F~~ _
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