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HomeMy WebLinkAbout0056 ' • Y.'7'9144. ~ ~~j lE :Et1Dr Insr.t t•fA y d~r ?!,.~+it ~elo~r r!~:.A art rot c:,o?:mtit~ LAST f:4.::E - Ffr:ST NAt.tu - ~.1:E~C)L~ N.:b1E 1. SEft\7CE Nl~:7BE-2 3r.C+RA!JE,F:A7~vRi2.48i:C b_p~l£OP K:.N+:(Joy,A:OAN, . . ~ . ~ . . ' /-1 . . YN~~, ` .w ` J. DFF`\P.Ti'Fi~T. C~::.SFUNcNI' .C~iD -~5. PIRCE GF k3iRTH (iiy o~! Staer w G,vn1ry) ~ 6. piqY td011li YEwFt V (3tt~..\~.!' Ar2 CL~S~ DATC ' _ . _ • p:krN . . , ~ . . ' e~ - . - - • O~ . . . 70. RACE ~ SFX c COLC~R HAtitj dCJIGR EYFS e. iiEtGHT L~.EiCHT 8. U.S. CITIZEK 9_ ti1AF~ITAL STA7US ~ ' ir ~ . _ _ . _L_ .~t _ ~ ~ c~YtS o~ . , d : _ _ t~vo:n~.~.,co. ~,i..,...~. ~__:~i~Ott IE~rEL 6. M,:A!OR GOURSE OZ i{ELD . - I ;Tid,t:iEL . i - i f 10. 7YPE OF TRAt:SFER Oit OtSCi1~~RGF. b. STAl10N OR l!1;'TA[,lAjtQ{i AT \tilitCH EFFE ~TED ~ . ~Q -~..'r . . ~ ~ ~ -~'~?~-~i :~rT; _ - Y W~c Fti:ASJr~ ~:~o nui-ri^Rin • • ~ - d PAY ~1QVTH YkAR y V EFFEC-I m . . . _ _ _ . _ TIVE :o C _ _ _ i 1 _ l . •_.7 . _ ` PA7E " ' . = V 12. 1lST Dl1~Y I~,SIGtv.'+:EhT M!D A1.VOR GO\iMAAD y 13c_,GHARAGTCR dF SERYSGE 6. IYPE OF CERTI'rICA7£ ~ ~ ~ - . . . ` . ISSUEO . . . ~ T• ~ - te. S~lECT1YE SEkY~:.E hUt.tisc_R 15. SSLlZCTIYE S~R':i:.t IOCAL E:O:.T.D ~:UN.~3ER, GiY, CUGNTY AfID 57ATE ~6. CATE INC~UCTED ~ ` DAY AfOPtfF: TY~AA. ~ .:C.f~ ~ ~ e . + W i t i-, ~ti,, • . - ~ _ . ' , - ~ 1 , 1%. C~ST~?i:.l Aft .REa CG~rtAt111V[~ "f0 IYH:CN R~~E 1~7 TRANSFERRED~ - - . _.s. , - f . ' ' . ' ' ' • - - , - _ f - - - . i6. , 'c1.r.117;aL GATF G•` ~9. CUftf217:'i ACTiVc`~ F_RYI~,E OiFiER TH4~! GY ItiDUCTIOV b. lERA: OF RESFRYE OCI~G:_V"J ~ DJ~TE OF ENTRY ~ a SOURCE OF ENTRY SF.,VI~E ' UA (S~ . MON fN YE4(: pio~,) D~Y MOYTH YFAR i = ?ENLISTEO;iint FnLttmecQ ?ENLiSTEU{Pr:or Ss~rkej ~tiEENl.tiI[O ' , --~1~ ?OT?fER: . . t . P1. P~~~? pfCL'i+~r: Ei;?151`:i~15 21. GHwt?E. kAtE OR Rar:ri AT T~M.E Oc 22. PLACE OF E~VTRY IAl1:1 CURriENT ACTIV£ SERVICE !Clr~ oad S?ofe) • ' ~~eTFiY ~NTO CURRENT ACTNE SCRYICE , ~ `i 23, KJ•dE OF F:i_CORJ AT TI~.SE OF 611TRY IN70 AGTIVi: SERYIGE 2q. 'STATEt.1ENT OF SERYIGE YEARS MONTHS DAYS • (Sr»r; AFD, G1y, ea•ry a.,d SroreJ o• NFT SERVI~E THiS PER~OD - ~ . • 1- - ' : • ~ CPE7TaetE _ _ • _ - , . , , - ~ fQR BAS~C 12~ GTHEH SERVICE : s 250• 6PEGwtii t:utdbER AFtO 6, REL4TE0 CIVICIA3Y OCCUPA710~ „jgpOSES ~31 IO:At (Une IU+Y.ne l21) ~ 11T~f : • AND D.O.T. NUMBER - - ' t ~ ' ' ' _ ~ TOTAt AGTtVE SERVICE ^ _ ` - i ~ - n - : , . - ^ - - p . " ~ - - c FOREIGIti AAtD/DR SEA SER~~G°_ - , + , 3 _ - - n+ 20. D..GCFt:.TIONS, MED.0.LS, 6tiXdES. CG~IMENUATIOhS, Cl7ATtOiVS Atv~7 GIl11PAKaN RJB00\S AY.'AR:~c~J OR AUTHOKITED ~ : _ f;._ :i. : • ~ a e~ " " ~ 27. \:frL1::; :a F.cCEtVEi? .U A R[SULT 0= ACI"FCN ~'~:7ti Gi= ::Y ro~ces iTi.~_s p~.d r:~t•. L` Ir,: ~nJ ~ ~ t~ , ~ r+ ' t~. SfKtiICE SC.HOOIS R4 4~llEGE., GCItESf tRAttiit:; C~~RSfS Aci_yCR PCSI-GRAt~1~tF CQBP,SES S!~CCESSFUIIY C6s'rIETFD 2J- O~HEH SE.°.VIGE TRAfN11.c . ~ m ~ - CC~'JNSES SUGC£SSFU~IT • Q SCN~704 OR CGl'.QSE DATES ilro/w-loj r lANOR COURS~S CGStPtEiEO a 6 1 c / C'`. ~ B ~ a-~.: ~~'tt~_'r~'i~j.: *t`n}!y\' . ~ e6 O .r - ~ h}~..+~+:- ~y •.y Gl ~1 • - - - M~~'~ .I"l~~ T ?.h. . . " . _ 2 _ t t~ i0 O f - ~~i ~N V i Y + • :i;: ; R i . , . ~ ~ ~ . Mr ~ ~p~i > ~ ~ 300_ GUYE.ZNTAENT LIFE INSUt2A:1CE IN FORCE • tc+~ • s ' Cd' ~y O ~ ~'Tt.r. ~ !y' ° i . ."1~:'~`}.t~;~w~ ~ c MO~ITH ' :.I.OT F:N-i r~~. 7 ~.1 ? YES ? 1~0 ~ . - - `~4. - ~ .s.~._.,-,~~, . . DSSCONT1t:UED ~ ~ W n _ "fi t-,.'~74'~,_ _ ~ , y 31 0. VA dENEF1T5 PREVtQUSIY APFLfEO FOR ~Spec;ly ryM1 s b. VA CLAIUI NUMElER ~ , ~ ~ ~ • _ C~ • ~ ~ 32. Rf.!dARKS ~ ,K; ~ t ra Q."~~ ~ _L... • : _ • _ _ii~.`1_ ~.~?i _ ` ~ ' r• 1 ' ' _.'.?t . ~ t. ~ • . i . -~J.`. ~ - - . ~ : ~ p _ ^ , J . . . ~'~i I ' _ ~f! rr~ , 1 ~ ~ ~ ~ ~ ~ Y~ ~ ~ i ~ ..~1'.' i Yr~~~- .u ip1~ ; ~ , 'e ~ Z w s-' f ~ T~ ~ ~ x •f ' i ~ t 37. PER:IAVENT A74~R(~S FOR 1dAri-i!V:a puRVUiES Ai7Ei: TFAL.S:ER ORv 34. S~GNA7UNE OP FEf.SaN~E RNNSFEgR~D~7~AFZGEO ~ ~ UtKNARGE ~Sr~~e?, YfD. C•y, Ca,n~~ w+.! Srutd - - y-,- _ t,X ~.j~ S, ~ /q • . ~ ~ ~ i s ~+!I ~ .y-t~~_ 35 a TYPkD NAt.iE, GRA-L A:`ID T!TLE OP AUlHQRiZ~VG OFfICFR b- St:a.•1J.Tti::E GF Gf{CrR J4~'. !~R(Z~Q~~'1'= _ i j " ~ j/ ~~f ~ i ~ . . . " ~ y~ ? 1 - ~ • ~T /~i ~ F 1~~J y;~~ QD ~;py 55 Z~ ~ wn~cM ~ oiso~ii~~ ~~u~ s:. AFIAfD FOn^~ES OF iiir Util(EO S1ATE~ .a' ~'t.!~~ . , ~ REPORT OF TRANSfEP. OR ~lS~HARGE .+t i Z~r 2 ~ . ° ~ 1~ 55 . ~ • ~ - . aomc - ~CE . ~ • . - . . - - _ - ~ - - _~r~ . . ~ . : . _ _ _