The URL can be used to link to this page

Home My WebLink About0876 ~ niis ~s iw wPOarw+r aEOORO ~r12~s SAFEGUIIRD IT. - 1. LAlT NAMEiitST NAME-MbOIE NAME 2 SEAVICE NUInIBER 1 SOCML SEC1~iITY MJYBEA ~ gp~gg ~~g 8~ 53 578 666 26T 70 6918 s. oEVMwrw~rir. co~rwor+Fwr ~v~o oa cu~ss s. ortr+oe. w?rE aw wwr+c • w?r a a~ a?r r~orrra rE~u ~ ~ 2? Ye~ 71 ?R1[Y A~ JR~DB 8(~T ~ ~ A s. u s anzEn s vu~cE of aar?~ tc~s ~a srr ~ ca.r~ a a~ anr wo~+rM rEwa ~ NO Sutter 80 ~ 4 D~o 45 W Oa SEl`~CT1VE SERVlCE NIM~BER • SEIECTIVE SERVICE LOCAI BOARO MlU~BER CRY. COIXiTY. STATE A!O Z~P COOE a DA7E WIJCTED 8 ~ 45 3~ ~ ~r• ~@rOe~ ~i owr ~ MorirN r~w , lla T/PE Of TRAr65FER OR 019C?WR<iE R STATIOM OR NSTALV1T10N AT WMCH EFFECTED ~ DIB~LRt~D F+ort Benning, c~A 31905 ~ ~ aEwson wno wur?~oarrr a c~ a?v ~rornH rewa ~R 635-212 SP8 2b4 a?~ 26 dul ?1 2 IAST OtlTY A5SKirM~ENT ANO MA/Oti CO~AMANO 13a CMARAGTER OF SERVICE 4 TYPE OP CERT1iCATE 45tlED ~ do D 5/31st Ini~ 197th Int Bde 3~? HOHQB~~E lbra 254? Hona ~ ~ OLSTRICT. ANEA CO~IYIAPID OR COfiPS TO M1MCH RESEiiVFsT TRAfVSFERRED 1S RE.El~l.15TMEMlT COOE ~ B&-3 ,.7. CURREM,ICTIVE SERVICE OTI~ER T.V,?. C~.INOl1CTON TFA..Of ~ a?TE OF Q.TR1, W765 OBIKL?7~0?~ a SOUiiCE OF ENTRY' x...? owr Mor+r?~ re~w „ `~"R ? ~ p u.~.. n 4 25 wug 6? ~ po~ a va~oe ae«xwa ~wsT.~xr 1A GRADE RATE OR RAM( AT TM~E OF za a~.ce oF Errrxr r~ro cur~xr ncrrve sewv~ce <as••~ ~•r? ' e~vrrir ir~ro u~nr wcrne svc OHB (1) SQ4 Bsd Bieeingen, tiereen~ - ~ 1. ?qNE OF RECOi70 AT 71ME OF EN7RY !(TO ACTNE SEI7VICE 22 STATEMENT OF SERVICE YEARS 1K}NTMS DAYS ~ l~wC t/R OO. ~0. ~~r wI lll Clil i 526 H. 11 th Strest ` a? ~ s~•+~ TM~s ~o0 3 11 2 ~ lrt. PS~]CCe St. ~it101e FL `~g r r.o or.FSe ~ O 10 18 M,..~ ~ . ~rv.,~ ~~,w?~ ~ u... ~ 4 9 20 11D4II o.°"T...,..e~R - < .TO 4 g 20 ~ Ai~or G~an HOHB ~~,,,~,,o,«~ ~gp~ 2 3 2 ~ z~. oECOw?noNS. r~wis. e~ocES_ ~+o~wnoHS. «rwn~s cwww~+ a~eeoNS ow w~m~o~zEo ~ Coabat Intantryaen BadBe (1at awas~i~~ Ltr Yedal, ~s~y Oo~endation Yadsl~ 2 OS Bars~ Yietaea Ses~rioe Yedal w/3 Bron$e 3tars, Yietneun Ceempaign lisdal R/1960 Derice, Vie Qrosa oY t~ry w/`Palm, Hational Delense 8ervice Yedal~ 3harpabooter (1F14), S:- ~ F ~EO ~no RECpRo ROCERCPOITRAS ~ CLERK CIRCUIT COIIRT 11ECORD YERIFIED~..,~.. ~ Z8 I I i9 AM'1 ~ ,e 26a NpP1 PAr PERq06 T~ME lOST ~Aerefr ? pI?VS ACCit~JED IEAVE PAiO Z7a NSVRANCE N FOtiCE AMOUNT OF AL10Tr7ENT ~ MON7:~ ALIOTMElIT 11w Y~v~l INStJ ~ L.'W'lll . ~T~~ ` YES NO ~ W~ H~NS Se@ $!lSr~Ce ? Q A~ B? V ~ z~ za vw cuw nu~.eew ~ seav~ce~r+ s c.a«~ u~ r~wnce covEw~ ~ ~ 80~'S ?:~o.~ p~.~ [~~15,000 ~ 30 ~EMARKS B1ood GrouPs Ot 4 ysers Bigh Sc2mol 66 ~ Y Ite~ 26b: lABF teaporary reeord forwerd~d to Finauce Center, U3A =or Settle~ent. ~ Tsble 2-5 ~S 601-210 appliea 22 d~a ez,ceea leave fro~s 21-26 3ep 70; 18 Doo 70- ~ ; 2 dan ?1 Ites 22oi Vietnav eerviee troms 4 Ye~y 69-11 ~pr ?0 31 oERM~V+fNT ApCWE55 ~OR tiu?iI.MR' PVf?PO'r.aES AFTER TttANSFER OR D~SCMAR('aE 32. SIC~aAtURE OF PERSI]N BEI-~f' TR EHRED Of1 OtSCNARGED ~ z ~s...c sm. c~.i. c~+o. ar.. or srr c.~.~ O V ~OC~ 21 ~C~ W i) T/PEO NAME. GR4DE AHO 7~TLE OF AUTNORIZM~O OFiKEFi ]4 SICi?iAtlXtE Oi OFF EO TO SK'.N ~ ~ fl~ ti. BSCsBI~~ .CM4 U$11~ ~at ~Qr /7~~~ soww PREv~OIK EO'iqP1S Of TH1$ fOi+M 1t cro ~a~o-~ea ~a6 ARIIED Of TlIE 1lNITED STAiE! . DD ' M~ 2!4 ARE p95plETE EiiECTIVE 1 1M16?i f, ~T ~ p~.•~~E ~ ~e ~ e~~;, 94 0 ~ _ . - . . - . _