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HomeMy WebLinkAbout1408 ~ ~ ~ll I~~R?NR M00~ . ff L WT NIMEfMT tiRY1C[ , i~ tOCIK !R~[/~ ~ 6 6 ~ a . a. aw~oE. wnTS ae ~r« ~ wn~~ onts ~ ~ pgC - 'w.~ .28 z u s. a ww~cE cc ~wrH w?•r • a.+~1 - a?r ra~1fM ~ "Q P~OSC6 1'3da °1"' 2 I+eb o. ~ ~ sE?~cre~ s~nncc ao~w +a~n. cmr, c~ou+rr. srw~ Mo an oooe ~ on~ ~aic~ ~ ro~rtM - renw 8 2 I.E Faar~ Pierce FL 33~ N~ l la TY!'t Of 71M~ Oft ~ 5TA71W Oq lQTI1LlAT10N AT 1MiCN 4FlCTED r ~ ~b~'~i HOOfl 'leZeB ~ wEwsA..~?w wur.+owrr a a?r r~oHrM ,~w • w'~ 9 OCt ?O ~ ~O I/LST OIJTY AM COWMO 1!a C?MRACTEA OF SERVICE ~ ? TYF'E OF CERTFICATE 65llED . ~ ~iC 2d~~ ~ ~nad IIto . ~ . as~acr. «+oo+~s,o vn.oH a~s~avsr rn~r,sr~o ia ~ ~ 6 2 Ii~- ~ ~ / 17. Q/RiEM AC71VE SERVICE 71Flt 7/MN @Y MalJC710N TERM OF e OATE OF EMTRV WT63 OBUC-+-nON a 90URCE OF £NTR1I_ . v ~ EfiUSTFD Ih~t lrirr~fl ~ ENLL.' TEO lAw ~r~nl ~ REEfilS7ED ~ YOMH YE/1R u oat ?3 ?~TM~ 3 12 oat 6 . fl PRIOR REfiII~AR Eti .I~GT 19 GRAO~ RATE OR fiMK AT Tw~ OF ?0. PIACE OF EMTR`! ~VTO Cl7RltfM AL7l/~ SERVICE ~6~ rf ~rl EMRY MO Cl1RRE1'(T AC7TIE.SHC ~ r ~ ~ 1. ND~E OF RECOttO AT 71rE OF EMRY l~i0 ACTIVE Sc.R :~:E STAtC_.EMT OF SEMIICE «K SPA Q~0. ~'+~R Atl YE11ti3 YOHnIS 011~15 1~28 N. ]2trh Str9e~. ` TMS ~"~O :r~ar~ xz~ r co ar+~ s~ O ~aa ~mE a aEtw tna.w+ ooctiw?TON wt~o C34 fon~c u~. ul N+ Lr w QQT. M,.~ O ~ 11820 I.~ i~pna • TOTAL1~"~ ~ ~ o t ~ wno~aw s~? ! ~.~o•=•..~.o.ownoras crr~r~ows ~no ieeeons ww~r~n aw ! p PS+e~tmm SeY'~loe Iiedal vI~I~ 2~ac1$A S Stture; N8t?i0aa.1 D~i~at18B S6rY3.Ce Iieci~3.; ~ ~ ' Rspubltc or Pie~triain Camp~ai.g~n Hedal; Heart3 ~P~ ~~~)3 j S~q~eart {1~60 NG); lst Cl (}nr (I~179 aL). . R E a w~ [ =t. Rd4Eli P TItA= - ~ " CLERK C~RC ~ NO { _ • ItECORD YERIFI 0 ' ~ ~ ~3 2 Ss PM'i~ ~ ~ ~i~3283 nor.s+ur pEwR~os r.~.e ~osr u?...4 a?vs ~ocwu~ ~wvE nwo . r+ww~NCx ~~owcE . wrou~r os wuorr~xr . roKrH ~ua~orr~otr a?~. ~ Ys11 ~ qo1A o~OOKr~ow~ W~ NONS (See 30) ~p~es.~,o ~ . ~ aa va a~. n~~ saw,rsaraiers awa~ ?rf wuewroc cov~~as ~ . - . G- ATTI ~ ' O w.oo - []~toa~ ? No~s =~5s000.00 - - ~ A. • 1 ~ 1~ Years School TabZs ~-1 ~ 601-280 applies : Blood t}roups " 0 Pos " ~ ~ Inclu~.ve datea of ee~vice 3n V3stua~s ~~ng aurt~eut pe~i~od at services SrgrGB- ; : btiov68 ~ f ~ Its~ 26bs 8zceea laame of llt da~ro S~o,t 22 ttQV 29Dso68 aa~d 3 t~hrn Oct 68. - ~ ~ ~ PEIrLMEM AOORE.SS iOR W1~N3 AFT~N TqAldf~ OR ~ ~~K MR q? ~R 1~t ~1 L?A+/ ~iA110E lANATtJ11E OI l~ON lBAO?tIMAf~I~ OR OMCMA00~ ~ 428 !t• 12th St - s • ~ ~ ~ ~ ~ ~ ~ _ ~ ~ r~.icxegr. xt~nocx, u,t, Fe, aCt ~s8t ~ ~ ~ ~ ~ ~ ~ « 214 ~~~ie"°"'....c ~TM; ~ ~ a.o~ ,...w..,~ ~ I~o.os.r ,wo ; ~ !'AT ~ 1MIA1~ a MqM~t ~ ~ ~ ~ ~ ~ ~'~KiR~' ?~~E1~~ ~ . - ~ ~ ~ ;y ~r . ~-"~..r~~< ,.~_y_».. ~ _ r..` . _ s?~~ .-T.e _~s~it? ~ _