HomeMy WebLinkAbout0516 ~~~(_)5t~,~ ~
~~1 LIiGEhUr Iwur! .\'iq ro tbe ilr~s bt(nm tvAic6 art so! applrcabft
1. LAST NAME-FIRST NAME-MIDDLE NANE 2. SERVICE NUMBER 3a. GRAOE, RATE OR RANK b. OATE OF RANKfUay, Montb,
u w+
Q ~ TAJ~L/M~L~ ~~i1~+ Diliyl{A~~ ['{A l~# V7v ~~lii~ P~e ~ arl n,„ VY
a ~4. OEPARTfvENT, G6MPONENT AND BR1thCH 5. PIAGE OF BIR?H tCi~y and State or Co~wtry) _ 6'DATE ~Y NIONTH YEAR
~ ~ GlJlSS ~ ~ ~
~ AFisY RA TJ1~A8(} AIS Terry l~fot~~a~t . • s~R H 27 A r 43
z ~7~- b. SEX C. COLOFt MAIR . COLdt 6YE5 e. HEIGHT J. WEiGHT 8. U.S. CITIZEN 9. MARITA~ STATtl~
IIA 1talC ' Br'oMn Blt~ 6' 181 [~~ES [~NO Yst`ried
~
u lOa. HIGNEST CIVfL1AN EOUCATiON LEVEL b. NNJ6R COURSE OR F~(.D ~ ~
A7TAIHED C• ~ I t. ~ w.
` 13 Yenrs Pe~ch •
~1 i4, TYPE OP TRANSFER OR DISGfURGE b. ST i~C~q/ TION AT WHICN EFFECTE~
Trans t o UBAR(3ee ~18 ) ~ Fort H~ailton 11ev _ Yort
s~ ~ t. HEASCk1 AND AUTHORITY ~ .j ' . ,ET;vE . OAY MOk^.'H YEAR
::r Q~ R~?r 7 AR 635-205 SPIt +lt~ll A:TB 1~~'].~ 'Relee?~ tQ~fl3+~e."+Ys R~tux'1c~eC _oarE 24 Fov i 65
i12. IAST OJTY ASSIGNM£kT AND MAJOR CO!~R~Ai1ND 13p, CHARACTER OF SERVICE b. TYPE OF CERTIFICATE
; H~l H9 CO 318 USASA L~ASA S~O~iABI~ 1~oIIe ~
! 14. SELEGTIVE SERViCE NUMBER 15. SELEGTIVE SERVICE l„OCAL BOARO MUf~ER, CITY, CO~NTY ANO STATE 16. OATE IN~7U'=iEJ .
~ DAY MQHTM ~~EAR
8 40 ; b3 ~ 123 ~U i~t Pierce lrl,oride ~ 1tA
~ < -
-"~~',I I
DISTRiGT OR AREA GOMMAND TO WHIGN RESERVIST TR/INSFEPRED
~~i
Trwns to U6AR Control ap (Reint) t~A,AC ~t I~uie Diisssouri
18. TERMiNAL DATE OR RESERVE 19. CURRENT ACTIVE SERVIGE ~TH~R THAN Q'I IHGUGTIOK b. TERM OF c. DATE fJF ENTRV
08LIGA710H Q. SOUitCE OF EtiTRY SERVIi,E
~N1.15TED fFntit E~n(ief tnl) ENLI EDIPrior Snr1:r1~R NLISTED) (y~u•s/ OAY MONTH ~YEAR
~i8 y J
n -1-6$ Va 1~ct ~~4o e 15 lRe?a' ~5 3 19 .Jtin ' 62
a OTHER;
'i20. pRIOR R£GUTAft ENLISTkENTS 21. GRAflE. RATE OR (tAN1C AT TIN£ OF 22. PLAGE OF ENTRY INTO GURRENT ACTIVE SERVIGEf~-ih unJ tt~;ri
yQne ENTRY INTQfiJ~E~~CTrvE S[RViCE g~orida
s•~~r
F23. HOME OF REGORD AT TIME OF ENTRY INTO ACTNE SERVICE~lnrrt, HFU. 24. STATEMENT OF SERVICE YEARS M04TH5 ~AYS
~ C1h. Coat rw/ Sto~rl •
o. (ti NET SEFNICE THIS PERIOD
1910 S ~ ~t ~j
S . GREOlTABLE -
FOR 9ASIG (ZI DTH£R SERVICE ~
~25a.5PEGIALTYN ~ RANOTITLE b. REl,A7EU ClVI~IAH OCCU~A710N AI~ pUHPO5F5 (3) TOTAL (Line (1IY line (2)
~'~~O ~ Cl. O. T. NUMBER b. T07AL Ri.11VE SERVICE
W, VOiCE IAtpT i NA c. ~o~icN ~+NO!oR -
j j26. DEGORATtONS, MEDALS. BADGES, COMP.~HnATIONS, CiTATIONS AND CAMPAIGN RIB~NS AWARpED OR AUTFiORIZED
w ~sxpert (81t~.e M-14 )
~
~27, 1M~lMDS REG£IVED AS'A R$SULT OF AGTION WITM ENEMY FORCES IP/act and dota, il knornl
l~one
~
r~, Sf~yKF 9pqplSptdplli~ES, CpItFGE itA1NNt'i CW[SES ANUlO!lOSi1:tADUATE CWKES SUCtESSFULLY CtlMPtETEO _ ?9.OTHER SERVICE TRAINING
$Ciqpl pR COi)R9E Oi1TES (Fm+a-To) M1~JOR COURSES ~~~5 SUCCFSSFULI~V
CONlPLET ED
~ ~ C
~ DLIFIC I
~ Presflritry Oe~lifornia ~ 6Sep52-SOct63 I,e~ng Czech ATP 21-ii4
Gr sAl~ioa~Tudpun
i30d. GOVERt/~ENT IIFE IHSUHANCE IN FqRCE ; O~u'+iOUNT 4F ALLqTAEM7 c. MONTH A~~OTMEHT
^ SCANT I NuED
~ ' 0 ~S x I~J ~ ~
o b. YA GLAIM NUMBER
31a, VA BEHEFITS PREYIqIISI.Y APPUEO FOR (Sp~ciJy ry~e)
t „~ra
, ; Aone
c~--
32. RFI~MRKS ~
; Iten ~3b : Dr?te or appoint~ent : 15 Ju~ 65
I,u~tp aum pe`ya~at maae for 4 d~aye accrued lea~ve
~ ~ Blood Group : A SSAI~ : 26~+ 4~4 0~43
~ I Sa'LI ~~0~ 000
Z;
W
2
r
~ 33. PER?MNENi ADORES5 F6R 1.MILING AURP'OSES AFT~H TRAtISFER OR IGNA URE OF PERS BEING t715GHARGED
t OIS~.lIARGE (Stnct, RFD. Gty, Cor.wty awd Statr)
ISaae ss ;°3 -
35a. TYPED i/A1+E, GRAOE AMO TITLE nF AUT ~ Z1YG OFFIGER 5 GNA7UR FIC AU7 EO TO SIGN
~ L L 9?SS~RT 2d LT A~T J~(,~ M;~(.`?~ ~
FOf~I REPL~E,~ ~Oi' 1 JU~ ~~l~H
DD ~ 214 ~5 O8~ ~ U AREPOR7QOF TRAHS ER OR' D 5CH RGES 1