HomeMy WebLinkAbout2399 , . 15507,g ~
TNIS IS M MIPORTANT RECORD
SAFEGUARD IT.
~ws? NAYE • f~RST NUIE - WODLE NAYE S. SERV~CE NuYOfR 1. SOC/AL SECYR~Tr NUYBEN
~ IIICY~Y, TI~~.:1S P~'~^iICi~ ~tA 12 2'T~; 528 11+2 22 2$~~i.2 ;
~ OEPARTYEMT. (.bYppyENr AMO Bp4NCN Wi C~.PU y~ ~.I~ApE, qATE OI~ RAMK S PA~ O~~ ~qMTw YEM ~
= A-L•iy ~A-I~~ SSG ~ q11NK 16 Feb 62
~
a u. s. c~T~z~N PLACE Oi 61R~N (C~7 ~~M~ w Corr~) o~r roMrw ver
~
`~.~s a Scranton, Pennsylvania e R;,, 23 3u1 29 ~
> ~y U~. SELECT WE SERV~CE NuYBER A SE~ECT~vE SERV/CE LOt~t BOAAD NUYSEN. C~TY. COUM7t~ SUTE AMD 2~G COOE DATE ~MOUCTEO
Hut
t DA~ YpNTM Y[M
W ~ ° ~tA • 2iA NA
1 t~. T~/VE O~ 7RANSi~i pq D~SCN1~qCsE 0. STATlpM pil INSTALLATIOM AT 1~NICN EFFECTEO -
~ ~.stired and Trans to USAi: - Valle~ Forge General Iiospital,Phoenil:ville,Pa ;
_ REAS()M ANO AUTM~A1T1/ ~
» . A. ORr YONt~1 vE~1!
o Title 10 (JS Code 3914 sF:; 23~ 20 fer~r retire~ent E`~~
E" 31 :iar 67
~p ~2. LAST Wt1/ A$SIGNYENf ANO YwJpR COWAND 1)~, CMAqAtTER OF ~py~CE d~~PE OF CERTIFICwTE ~StYEO
: Co8 (dtchedCoC} (P~CV)SpTrpsiTSAGFtTJix:iJ }:ONO:?A3I.E DD Form 363A
Z
< D~STRIC7, AqEA COrYAND OR GORPS TO ~ICM qESERVIS~ TR1~MSiERRE~ 1S. REEttI~STYEMT COOE
r
~ Trrins to US~LR Con Gp (:~etired) US1!!1C St. Louis, :io. 63132
~6 TEAWN~L OATE O~ p[SERVE~ 11. CYRNENT ACTIVE SERVICE O~NER TMIW BY INO{lCT~ON d TERH Of ; pATE O~ ENT4v
UYT~S OlUGATION t SOIIqCE OF ENTRY: SEqv~CE
DAY YOMTM ~EM ~~r~i~ OA~ YONTM ~E~R
~~EN~1S7E0lFu.tFsGafaent) !~EML15TE0(PnwServ~od ~~REEnL15tED
:~A t ';pTNER I} 2b AiL~ 63
PNWM REGUTAR ENLIST~MTS .RApE. R/1rE Op R1~NR AT TIYE OF m. pLACE OF ENT1~r IM70 GUARENT ~Ci~VE SERVICE fC~lY ia SIYOJ
ENTRY IMTO CUR~ENT ACTIVE SVG =
4 SSG E-o Fort Dix~ i:.J. i
2+. MqrE OF RECOpO A7 7u~E OF ENTqr ~Nip ACT~vE SEAVICE 2i STATEYEMT pF SEqV1CE •EANS rOKTNS OAVS t
~ crr.e~et. RFD. C1O•, C~utX. A«e a~d Zy!P Co/e) i
1oU3 ~Q1o~QS' StrQeij 1~1 wETitwvKE~N~fKR100 k
CNEMr1~BLE ~ O ~
San Frt3ncisco 1J71~~ ~ sOw ewy~ pwr ~b OTN[R fEwvKE
p1MP'OSES .
77~. SPEC74LTV NUYSER ~ TITIE A RELATEO CIVILIAM OCCUPATION AI~D TOT~L (LIw fl) LW ()y ~ S ~ I
O.O. T. N{IYBER
F 11B40 Lt ~~~g . S- TOTAL ACT1V[ SERVIC! ~ O ~ '
° ZILfLi13t] Y,pAB c. F011EIGN ANO pq Z[A sQRV~CE
~ 0 ~ 0 ~
V 2~. OECONAT1pN5. YEOALS. ~~OGES. COYYEyDAT~OMS. C1T11TION5 ANO GA~AIGN p~9MMS AfAAOfO dt AUTNpRIZEO
> "
~ Cood Conduct ::edal F(LEO ANO AE~pRD Q
ST. t,UCI~ COUNTY. ~ =
RECORD VERIFIEp ;r
2S_ EOUCwT~oN wMO TwMM~MG COYPLE7EO i
~ ~ {
; 1~~~ s~~ooi ~~n ~7 APR t 7 AM ( I: yg ~
k
~ ROGEk r'~?iTRtiS
~
CLERK CIRCUIT COURT ,
26a. NOM•PAY PERIODS T~YE LOS~ (A`et~edwt R OA`/S ACGtUEO LEAVE PMD 27~. ~NSUNANCE M FORCE R ArDUNT OF ALLOTYENT _ YONTN nl1_OTYEMT ~
r T~o }"e~l (M$~1 p (/SG~./) aseo»t~MV¢o
- < i
i si
j ;:one 57 ,-tYEi xMO ~ t,;A IIA
Or
! i V 7!. VA CLl4Y MUMOFR b. ~Ry~~p~EN'S GROYA LIfE INSyRA1KE COVEMA4E
>
t~ *
G jYO]'1~ ~ S~O.000 $.000 1 MONE
1D. RCYMRS ~
1~0 {/1111Qi ~OJt wader ~O WV
` s Para 10 A:~: 60~-210 applies
W Blood Groupt "ON .
; ~
f
i
E )1. ?EIWANENT AODRESi FOR YAILINC PUR~OSES AiTEI~ TR M M yGyATURE OF PfNSON SE1M6 TN~1MSiEMEO OR 01SCNANGED "
E Z lShse~. RPD. C.7. Cawlr. Stxe w/ d.lP Core) {
E s~t. 4, P.O. Box 1558 ~
; ~ Fort Yierce, Florida 33450 ~
; ~
Z TYP[O MAYE. GI~AOE ANO TIfLE Oi AUTIfpR12N1G Ofi/Cl1~ H. SIGNATUR! O~ OFfIC(1~ /WTMp1t12ED TO WiM
W
i ~ DOi:E;I.D P. :~It^~t:, CPT,:iSC,n5ST.An,TUTA~:T d
Y
f DD 214 • ~a.w~ ~ .M~s Fa,.~ ~ : ~ ~c ~s ~ un~c sr~~s ~
~ /YtM ~EafOLtT! EiiECT1vE 1 J~~~ ~
~ ~ ~ ~ ~uH~~
_ . " - _
_
~ ~