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HomeMy WebLinkAbout2202 ~ ~~~~5~ TNIS IS AN NAORTANT AECORD ~v ~ ~ iAFEGUARD IT. ~ i f ~,wST '~~LE - f~RS~ +tw~tE - Y~OO~E ~+wE 2. SEwv~GE NureER ~ 7. SOCeAL SECUR~Tr Mtiy9Ew ; < Syl.s'3II.g dYi~i 11it~E ~A ~ ~ p~3p ~ ~ ~ ~EP~nr~rENr COMVONEMT AND BAANCN pR CtA$$ Ss. GRAOE. RATE Qti AANK p PA11 f DA~ V(~`a1TM •[AA D~*E p 1i/? t/l~, GNAOE qANK ~ ~ J ~ Y T- U. S GITiZcH I•. PLACE Of eIATM(C~IY.a~JS1Y~erCw•rr~•i - DA11 YpytM ?EM ~ ~ OA7E BIA TH ~ 0 s Q j &aa ~?aLa~io~ ~a~s ~ i~s ~d? >r S°t.EtT~vE SEqv~CE HuyB_R 6. SELE~T~vf SENV~CE LOCAL BO~aG r.~~5ER G~v COU`~~r. S~wtE Avp 2~P CODE - OwTE tMOUCTEO ~Vt V~~ J.~? YOM7N rE~ ~r < .~ro + ~ ~ 1 • Sy T1?E OF iqANSiER ~A D.S~,NI~AG~ O S7A7/Wr OR :N$TALLATIMI A~ f~..:CH EiiECTE~ ~ w ; DYaCi~Aii~ lost l~ J1r ton 9 ~ u ~7E~SON ANO AUTs~pR/7V d. r rOrte ?EM f J~ a,~,~~ TT ~t ~~f~ EiFECTIV ~r : • t~ T~ ~~i ii S[-~ i~ OwTE A ~ i,y t _ /L Cv p ~O lj. LI~ST DUTV ASSIGNVEN/ AND YA10R GOMMAAD s3• CM~RAG7EN 0~ SE~3VCCE b TVOS O~ LERTi~~CAT~ ISSUEO f t UI ! ~ 9~S r~ I DC ~DA03~t9~i 11~ ~6~ ' ~STRtCf AqEA ~OYMAND OF1 [OAQ> ~O w~:CH N:SERYtS~ tRMSFERPEO l5. REENL~STYFMT CpDE _ r ~ , r , ~ i ~~7C UY~•5 O~IiGAT~ONSENVE ~7. CuqRENT w~T~vE SEat•~~c nruco THAr. Bv ~~tQ{/C7~0~+ •ERf, Oi r. 011TE O~ EMTP? O~~ YOwi~f ~Ey~ ' SJ4RCE Oi EMTPV~ SERVICE /r~ux) DAY ~Yp1~TM ~EM ~ ~ENL~STED;F~~s~£yJ~.lA.wl) _~EN.~S~ED!Pr~orSetn,e{ _ A£FNLiS~ED ~ , ~~Ew . ~S. ~~OR ~1CGULAR ~NL~SrYENTS ~9 GNADE qATE OA AAtiK AT T~.uE Oc 2U, p~,11CE OF EMTR~ ~NTp CURREN~ wCT:yE SERV~CE (C~t~~ +ndStat~1 ~ f ENlqY ;NTO CUAREMT AC~tVE SVC ^~w~ ~ ~ ~ 7~ wpYE OF qECOpD wT TiYE O~ E~tTqv +N70 4C~~VE SERVKE 27. STATEYENT OF SERVI~E VEAqS ~OY~tiS OArS !Ar~rf. RFD. G:7~. i. oen~r. Av~ ~.J lfP Codei ~ - a Iti MET SEnVKE TNISK~110D ~ CREO~TABIE ~OR BALC PAY ~r OTME~1 SE11v~CE ~ oU4POSE5 Z~A.SPEC~ALTY ryVY9ER ~ T~r~,E 6. REL4~ED C~VeC~AI~ pCCUpA710M IIND +3~ rorwt ~tr~<(l~ ~hr~ Llrw t~L_1 D.D. ~ NUyBEw ~ F~. ~ ~ h T6TA~ ACTWE iERVtCE < j ~ FpqE~GH 11N0 OR SE1~ SERYICE ' U il OECOR~TipNS yE0~115 BApGES CpYaR~ND+~ O~+i C,TATIpNS AMD CAYOAIGN RrB80N5 ~?~ARDED OR AUTNORILED > N ~ i ` _ ; oLERR C R t ~T ~ ~ . 15. EDUCATIOM MID TR~IMING COMV~ETED ' 12 Z~rs - ~e~~ ` ~ ~ , ' ltil a~io~ ~~~~nrs ~c+rnr - 1~a~ae~ =~iea~ Ca?~+~ ~ , /~~~,y~ ~~~y 4 ~ ~ ~ {4711 ~ 251453 i i ~ I i I6a. !ION~P~v PEp~ODS ~~YE LOST •Vrnr/.r.R d DA~IS ACCRUEO LEAVE oND I1+ INStlRANCE Nt ~ORCE 6. AYOUNT O~ ALLOTYENT c, YONfH ALLUTYEMr Tn.~ Yw.r INSiJ w USGLf~ p/SCQNT~NUEO < l` y` ~ y0 ~ ~ ~ ~-Y[5 NO S L~ pr ~7 ~Y iV s. YR CIA~Y NUYBER 29 SERyICEYEM'S GnOUO L'~E INSVR~YCE COVEA~GE > << ' G ~ St0 fi00 ~ S~ OOD NOtiE ~ ~w 7D. qFjtAqKS I~' 3a~ ~1 ~Js (P) ly~'Ld ls J+sn 6E Dtr~it 1~ 6S ° 62~ood i+anoc:ps ~ ; = iL~w 31~ 1509 t%ora~natlo :.Y~s~ ~ar~ ~'1~=ro~~ Pl+or'.Ids ~ ~ 3' P£~1MEN~ AGCRESS fOAV~'L•N~ PuAaOSES A~?ER ~R N EF 7A :~~~r~? I ~ Str~.r. F(f0. Gr.. (~-xnn Sr~tr aw.1 ZIPC.ad~1 S~GMAi RE O~ OEN:Wa Bf•VG TRiWS~EIwEOOR D~SCN~AGEO ~ O i ' f SN IL~a ~ - ~ ~ ~ ~taEO tiwE. ;w~OE ~tiD ~,T - • ~ = ~ lE O~ ~u~.~ow~i WG O«•CEN H S~ •t4NE O~ Ois~rEw Au 11~2E0 ~O S~GM ' , F ~ :;~~:~'kol~t 3. :'a?~:I~t~,?!.?~A~tIC~,Assi id,~i~r#, ~ ~ i ~OR~I F~E~.G..~S ED~~~OK O• 1..,5 rp11IY ' ~ DD ~~~nM •~fGSSO~IrEs~sECr :E ~~~~{1 ~'GI'n•IM~O~lft-ISS s~ E~ A S vQ~~ 212 ~~.~i ~~?Vl.r REPORT Of TRANSFER OR dSCHARGE 4 , _ . _ . _