HomeMy WebLinkAbout0387 . - - - - . . . - ~ - - - - ~945t11 S °
~ : rn~s ~s ~ rrt~oxrn+vr REOOw
' SAFEGOAlt0/T. ;
~wsr N~rc - r~wsT w~r~ - r~oo~[ N~re s sawv~tc Nuw[w l. fOC1AL ftCUMTY NYY~L11
; i~QLLI~l~1S sii'iNtr I~QlI
0 p~rMtYtMT, COY~OM[N~ ANO qANCM OI~ CLASf S~. G11AD[. RAT[ 011 11ANK \ PAY pAT! 0~1/ rOUTN T~YI .
J . 6RApE
= 1il ~ ~ iT~ A! 11UIK }
AS V ~7A
~ 7. Y. L C1TIZ6N ~LACL O~ ~IATM (C~b I10 Sf~t1 M C~1tr/) ' ~ OAT~ OA~ YOMTM KM ~ - i
~ ~TCS Q p l i• ~ii~lV~ liAKWA~ ~MTM 6 ~V i .
~y ~0~. SELECTWE SEMICE NVrYEI~ ? SEIECTtVE S[RV1C! IOCAI ~OARO MYY~fR. CIT1/. COUNTV_ f7ATE ANO Zlr COOE c. OAT[ INDYCTEO f
~-V< . ~ . . . OAt YOMTM YtM
r ~C <
8 1~0 !t8 626 ~I~O, ZT, PIffitGi S?. I~TCII~ FLO~I 1tOT
M 11~. TrPE OF TRANiidt 011 O~SCMA116E ~~~Y~ ~ STATION OR ~MSTA66ATqM AT rM/CN EFF[CT[O ~
Y
u
r
u t. REA3W AND AUTMp11rY 0~~~ ~~O _A. ~ E/FEC71V OI1T nOwtM ~EYt
~ inr~~w
~ 04TE ~ ~J~JN TO
<
e~ r
. 0~ IL IAST OYTY ASSIGNMEMf ANO ~J0~1 CO~AMO ~1L CMARAC~EI~ OF SEIIYICE ? T1/K OF CE11TIi1CATt ItSUEO -
~ II83 liC CJFF~Y (D~ 860) HONORL~ 9~8 R~iARES
~ 1~. qSTNICT, MEA GOrYANO OR CORPS TO ~~CN 11ESE11VIST TRANSFERAEO ~S. 11EENL~STYENT GODE
~ (~0~ NAVAI. RI'$IItVE HATiP~OIdS~i CF~iTffi~~~ BA~iBiRID(Tr$ 21~0~'j 1~3R
7ERWNAL OATE O~ 11ESE1~VE/ 17. CyMENT ACT~VE SENViCE OTME/1 TMAM ~r INOUCTION ~E~ Oi c. O~~E Oi ENTN~
UYT~S OCLt6~T10N ~~qjpCE Oi lNTl~v: ~ ~ SERVKE
OA1I rOMTM r~M (r~y~) O~~ rOMTN rCM ~
~ ENl15TE0 (FirN EJ~sew~w0 QlML~St[O (Ynw S~r.1c~) ~
]11EENUSTED .
20 .ltlrt 74 oo.~ER ~ oe o5 sap 66 ~
1~. PR~pR REGYLAR EMLIS7YENTS 1!. GA~OE, RATE ON RANR AT T WE O~ m. PIAC[ ~I ENTI~Y ~MTp CURNENT AC~IV! SEI~WCE (C~f/ r1 Sf~[f) ~
HNTI~Y IMTO CYRIICMT ACTIVE SVC
~
, ~ ~ ~
' 21. MOY! Of 11[CONO AT TIYE Oi EMTNY INTO ACTryE SERVICE 2Z STAT(l1ENT O~ SEI~WCE YEA1~S YDMTMS OArS ~
~~I (StrMt. RFD. Clry. Co.sy. Sur~ d ZIP CNe) ~
i pIp A~ ~A1 T?~/~T~~T~ ~n NET HAVK[ TMIlKRpO ~
I r 1• i~i~VO~ ~71 • J~/ViB' ri/S• CAEWTw~LE ~ . ~
{ I0~1 049C PAY IT OiM[q f[RVIC[
~ oIiRPOSEi
~ tla SvEC~ALn NYYOER ~ T~TLE L REI~TED CIVIl1AN OCCUP~TION ANO 17f 70TIL (lw (I) /4~ LY~ fT1~ 3
D.O.T. N{M~BER
~ Q1i IAQ ~/yy~IMM ~ ` ~OTAL ACTIVE tERV/CE ~
i W~ LVB~rrw WW
o f c. FonEwr u~o•ow scw stwv~cE ~ ~
Y
V 21. OECORATtON3. YlOALS. SAOGES. COYYCNOATtONS. CITAT~OMS ANO CAYOAION R1a90NS AIIANOE0011 AUTNpNIZEO ~ -
Y
~ Na~Mlil ~P~ISA SErPiCO HA~il Z z z z z Z I F
Z Z Z Z Z 2 I 2~ Z Z Z Z X '
z z z a z z a ;
2S_ EOYCA7WM ANO TAAI~l111G CpYK[TEO ~ ~
NTC FOR_ 9N/H~ P~OR SN/ l+IIt FOR P036c2/~iTC FOB C33. a z z - z z
Datenaiw DriTing Gyrse (1) Z Z Z Z Z Z Z Z
sa~ni.tat3on ana Basic xatn ( 5) . z z z z Z z z z
Z Z Z 2 Z Z Z Z Z Z Z Z Z
a z z a a x z Y g z z z z
;
2f~. MOM-PAY OERIOOS~TIYE LOST (Precedyit R OAYS ACCNUEO LEAVE YAtD Z1~. ~NSURAMCE M fONCE AMDYNT OF A{,LOTYENT . YONtN ALLOTYEMT ~
r.e r~...~ flllW wf/SGL1) WSCONr~MU[O
< v
~p ~ n~ ~ ~rEi [~MO s NA
r ~1 ~itii
i; s. VA CLNY NyWER S. SEMICErEN'S W10UP L~FE INSURANCE COV[N1~
s~a.v: ce) s-r. LUCIE COUNTY. .
>`w G j~jt ~ sw.ooo pss.ooo aNOME iZFCORn VERIFIEO
~ . r .
ao. wcrwrtKS i
~ 13(b) NO DI3CHII~G$ C$RTIF.ICAT$ I9SU~ RT TIH$ UF 3~ARATION. '~0 JU~ I I PM ;
~ -
W ~uax scxooL: 04 ~ `
r ;?c~,^,~R r 17R1+S
~ CLERK CIRC IT COUR
PEAYAMEMT AOORESS ~OR YAlLIN6 VllNPOSES AFT[R TNAN ~ M 3j, ~GMATURE O~ PEpSOM BE~NG TRANfFEMfO OA pSCMAqGEO
Z (StnM. RFD. C.ry. Cawy. Sarr ~nI ZIA Ced~) ~ I
~ 1605 N..2Lt 3treet, F~rt Pie~ce~ FLA. J.G~.
<
~ ;
~ L. 71/P[p MAY[. GRADE ANO TIrLE O~ AUTNOR121NG Ofi1CER 1~. S/GM Y f ~i AUT ZE O SWM
2 _ , s
r
x ~
~ . $.~"~"R~~~R~ U~~1~ ~ ~8'~ • ~ ~
FORM O'EVIOYf [qTqRf 0/ T111f~fORY~M[O~fOI[T[. /Y~~ED rVR~~S Vr ~E ~~TED STATES ~
DD , 214 N
REPORT OF TRAIlSFER OR CfSCNARGE
s ~r. o:ez.~:~i-c.co
~
. - - - - - =
- ~;.e=~• E - w t ~ _
.4~' x _
_ '~:,,F=e`=?'~ '