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HomeMy WebLinkAbout1243 ~~J~~~ ~ ? ~ ~ 3~~ 148~3 ,.,,~.,w. . 1. LaST I~AME - P~RST NAi.iE - MiD7iE ^AME GHAOE. RATE OR RANK ~ DA7E OF RA~aK ~D.y x.. ~ 14 6Tt~ b~ ~ ~cs ~?r.~ ~s ~ : ~csp1 - - ~ ~ ; 4. DEPARTA7ENT. CJMPONE~iT AnD ^ S. i~~ _ ~ OAY M0~1TN-? YEAR < BpRANCc~+tODRf~iAp55 ~6FE j ~ A[1Cii II~#lL Ni'i P~ ~ BiRTH 2'~ 7• RACE ~ SEX ~ COLOR HA1R t COLOR EYES ~ NEIGHT 1 WEIGHT 9. U.S. C~t~2EN 9. MwRiTwL Sr.~*u5 c~II 1i?I$ ~ram , Aass1 i 5, 7~ - ~ ES ~ No ~ 10 • HIGNES7C~V~~~Ah EOU~AT~O1V LEVEL b MAJORCOiJ R S E O R FI EL O ~ aTTw~'.ED 8 YRS BI~i 11 • ~YPE O~ TRA~.SfE~t OR DiS::NARGE STATION OR INSTALUTION AT WHICM EFFECTEO ~ Q ,R6161Sa tr0 U~R (SAA ~ W W i a. REASO\ AND AUTNOR!TV Q~.~ A tD L ~r-~~j ~Q~'!L { OAY , 61T~07'tTH ~1 YEAR rsr c ww c~~v7 ~ 77~v EFFEC-. TIVE t ~ ( oc ; - DATE1~_ : Z=~~ ~ ~ e TvPE Oi CERT~F~C~TE a N~, 12, lASTDUTYA551GNNENTAN0~IAJOQCOMYA ~ ~f~C~~A~'i~~~V~'E 155UE0 ~b ~ g ' ~ Y Co IS = 14. S~lECT1YE 5£RVIGE NUN6ER SELECTIVE SERViCE tAC L BOARD NUMBER. GITY. CO AI'~ A 16. DATE INDULTEO ---T~- ----T---T- . - DAY TMQNTH VEAR i ~ : ~ ~ V<~ i ~ i w>-a; 2 ' ~ -1-- ~ t7_ D~STRICT Oit AREA COMMANO TO WHICH IST TRANSFERRED . ~ w N - N Reless C ` IV'IIS` . 18. TERMIN DA7EOF ~9. CUR A E SE VICE OTHER AN B 1 ION . 1. TERM OF . ~ATE OF EnTRY ~ RESERYE~IGATION a50URCEOFENiRV ' ' , ~ ~ $ERVICE ~ ~ DAY NQNTH ~ YEAR ~ ENLISTE011ine [dir.wh ~ ENUSTE0IP.A. S~ae~ ? REE[ilISTED ~ '~AY MO`~TN ' YEnR g . ~ OTH~QA~ Pe~ Ac 1 dtd 1 ` ~ t ; Zp. pRIpR ~A11 q~USTYFNTS 21. GRADE.RATEORRANKATTIMEOF 22. PLACEOFENTRY OCVRRtT~lTACTIVESERVICE~C1.•a S••~~~ - £NTRY 1NTOCURAEHT AGTIVE SERVIC ~ . ~ ~ Naae P'Y'r Faact Pei.sw Fls 1 ! :23. HOMEOFREGORDATTIMEOf~5MRY1N'TOACTIYESERVICE ~a. ST~TEYEl/TOiSERV~CE iNFJ?RS~MCNTNSTDAVS ~ IS1'~ R/D. C~~ Ga.4r d Sy.) . ~ Q ~O '~~~j ~ ~ b~• ~T~ ItINETSiAVICETHISPEFtiOD iKl 'Fcact et Lu~c3,e `oR ~ Z' on,~ 5~"„E _ 'Q PAY w _._.t!~7. 25 a SP~CfALYY NVMBER AND ~ ~ RElATEO CIVILIAN OCQ~A770N ~S I~~70TAL ller p)+~r R11 L J . 1 TOTAI AGTIVE SERVIGE . T16~a.0o- ~ ~]~iaa"~" - ~ . _ - ~ _ o,•_~y O ~tO a FOREIGN AND~OR SEA SERV ICE . ~ O O__ _ 1._ _ O i44 •.wa. - • 26_ DECORA710tifi. MEDAlS. BADGES. COMMENDATIONS. CITATIONS 1?HD CAMPAIC'iN R18BOtf~ AWARDED OR A{JTFiOR1ZED U I > ' oc ~ , ~ ,~Cpes't ~A~.~~ ~,1) - - - • 27. WOUNOS RECEIVEO AS A RESUIT OF ACTION WITH ENEMY fORCES d~+~. U~•) ~ Z,~5£RYlCE SCMOOlS OR iOL~E6E5. COLIEGE TRAMYNG CWRSES ANO/OR POST-CRADUATE COURSES SUCCESSfUILT COYPI.ETEO 1Y. OTHER SERVtCE TRAIhiNG SGH004- ORGOURSE OATES (/n~ - T~) MAJOR GOURSES COURSES SUCCESSFULLv , ~ , ` ~ ~ COMPlETEO ~ I~O~ ~ ! ~ ~G~IB ~ 30.~ GOVERNMENT IIFE 1~lSURANCE IN FORCE ~ ? AYOUNT OF ALLOTMEM ~ MONTH ALLOTMENT ~ DISCq~(jINUEO ~ ~ f ?YES ~NO 1~~ ` , ~ ~ ~ ~ , VA CLAIM NUMBER . 31 VA BENEFITS PREV~OUSLY APPLIEO FOR {Spciti q7r1 C~ E:l ~ C~~,r - > iVQ,y ':7 ~ . r ~L;• 7 ~ a~ • 32. REMARKS ~SS~t: u2.28-7625 l ~`~l ! ~ ;I,m,p em~ p.~y.eat maae ioT ~3 ~ accured ],save n ~ E:, 1 ~ ~ : ` : Q jlte~ ].3a~Releaeed !`raa aatiTe ~nt~ a~ returnsd to IIS~S to ca~pl,ste ~~ning <~$er~iae oblig,atiaaa a~ 1 year 9=antha 1 d~• - v ~ ' . _cjC{C~ Z ~ f f:Cl : Ci~fitllA' Ere• ~ I ~ N.. < 33. PERMANEMT ADDRE55 FOR MAILING PURPOSES AFTER TRANSFER OR 34. SIGNATUR 7ED OR DISGHARGED DISCHARGE 1Snert. R/D. Cs~. Cwaq d Sw) ~ ~ 35 ~ TYPED NAME. GRADE ANO TITLE OF AVTHORIZING OFFICER SI TO a aa~.Y ~a.~ 57'1~ ~cat ~r(s) p~s a~ F^RM ~tEPlACES EpTqN OF ~,u~ s:. ARME~ FOR F U RED ATES O R ~ DD 5= Z14 M~`~'CM K osso~c.E. REPORT OF TRANSFHt OR DISCHARGE $Q;,~ - ~.~r~ - : _ ;~~~:fi.-.~ ~ ~ •