HomeMy WebLinkAbout2351 yG
rnis ~s ~w i~r~wr REOORO ~
suFECU~ro ~T.
1 IAST NAMEFMtST NAME~MDOLE NwME 2. SERVICE NWBER 1''~C1AL SECUQITV NUMBER
` ~ B~.L2 VIIi~IL 266 8 9702
~ t OEWIRTMENT COMPOPIENT A!O OR ClAS$ Sa GftADE RATE OR RANK~ \ PA~A~ 6 DATE ~ OAY MONTN VEM
a~a Ra c$ sr-5 s-5 ~ s~ o
7 V 5. pTt2EN ~ l RACE OF BYtTN 1C~0 ~+~f Srtr r Qw's) 9 OATE DAV . MON7M tlEAR
~ `rts p P~ FL . ~TH
~ 10~ SEIECTriE SERV~CE MlMBER ~ SEtECTrvE SERVICE LOCM. BO~RD Nu~BER C~7v COUNTY STATE ANO ZtP COOE t. pATE W0IJCTEO
owr Mavt?~ vFwrt
8~0 49 414 ~ No 4o Fr ~xcs ~t. 33450 ~
lla TIPE OF TRANSFER OR OISCNARGE ? STATION OR INSTALLATION AT NMICH EFFECTED ~ ~
TRF TO DS?8 (SSS 16) FT L~ONARD I~i00D l~A ' i
e. REJ?SON AND AUTF10ftIT/ & L OAV MONTH tlEAR ~
T.~~~p Iy~~p/~p~p~}ppp~~~~p FFECTIVE p tt
t< i~i~ 11rr ~OQ/~5L JaCIV ~ ~1Y11 i1~i~WD DATE ZV AV~ Z
Op 12 lAST OVr11 ASSIGNMENT AND MAJOft CWAMI~NDm p 13a CMARACTER OF SERVICE k TYPE OF CERTIFICATE ISSUEO
W D ~ ~ ~
~ u~r ~ IIsarc ~ vse ~ '
~ l~ 04TRICT AREA COMMANO OR CORPS TO MINCM RESERVtST TRANSFERRE~ I5. REEfVl1STMENT CODE t
r $$-3B i
~RF TO ~t (i01~T (~P
RVE~ 17 CVRRENT ACTIYE SERVICE OTHER TNNi BV N~10UCTIOfi _E~E~EOF r. DATE OF EMTRY
WMT65 OBl1GAT10P~ ~ Sa1RCE Of ENTRY
r N H YEAR Y~~~ DA~/ MONTH YEAR
~ E~AiSTED Iflnt E.ierwP ~ ENLISTEU IPrier Srni~rl ~ REENLISTED Iy~ LA
~ ~V ~5 ~OiHER GV ~V V~
~ 6 PR~OR REGtAAR ENUSTMENT 19. GR/1DE. rtATE OR RANK AT TWIE OF 20 R.ACE OF ENTRY WTO CURRENT ACTIVE SERV~CE (Qry ~wt 51~41 .
~ ENTRY lITO CURRENT ACTIVE SVC
; PT JAC~90N, $C
i 1?qME OF RECOitD AT TWIE OF ENTRV M1T0 ACTNE SERVICE 22. STATEMENT OF SERVICE YEARS MONTHS QAYS
57aet RFA QO. fs~0 =Ir Cwirl
~ ~8 avs a . <1) NET SERVICE TH~S PERIOD 2
3~~ ~S~' ~CIB~ ~vuR?~ES oT?~ seHV~ce 0 0 6
2RI-~v~ ~.Wa1I~ a 00 TTE~~MUAN OCCUPATION ANO 7VTAL Il.we Ill/ia !at Itl Z ~O
R
t ~p~~p c ~ 1'YMNN • TOTAL /1CTIVE SERNICE Z ~O
O A*i\IL1'17 a FORE1CsN AND~OR SEA SERVICE VISTNAK ~ O ~ ZS
Y
Y 2f. OECORATIOP~S. ~OAlS. BADGES. COMMENDATIONS. CRATIONS AND CAIJPAICaN RIBBONS AWAROED OR AUT?iOitIZED
~ OS SVC H~RS ( 2) AROOK Ai~a~u~
v5l+It q/2 BSS EZ qII~L H~D x1 b ~~ca~ ~
R~Nt~?I it/60 DS9 . ,
~s eouc~ wno coMV~eTeo ~F~ORu V~'f:~F1E0
~ e~s ~~o-pzor~R ca~ Txa ~ 9 1144 AH''3
ffi
R
S O F 8
0
N D
I
S
C R t
lTP 21-13.1~ ,
ooDS oF ooNnvc~r ~ 2515'79 '
~r, ~osricg Txa
2Ga ?iON PAV PERIOOS T1ME 105T lMrcrdw k OAYS ACCRUED IEAVE PAIO 27a INSURANCE W FORCE R AMOl1NT OF ALLOTMENT r. MONTH ALLOTMENT i
` ~ (NSL ~r USC/ll pSCONTWtIED :
~o o,~s ~ ~ xs x~ ~
~Y ~p~~V y Vy ~O 2B. VA CLAMt NUMBER 29. SERVICEMEN'S GROl1P LFE WSURANCE COVERAGE ~
C ~ ~i15.00D ? f10.000 ~f5.000 ? NOF~E ~
~ B~UC 12 YRS ffiDOD (~OIIPs 't0" ~
r~t,s 2-5 ~ 6oi-uo ~~s
v~~ svc: 26,rvi.To r~v 23~cu,Ti; n~cHIxs-~s, ~~-ao
13 D1T3 S1C LV F~OMs 2-7!lAR72j 26~C71-1JAN72
5 nucs iosr ~ io o~c 972 ~H: i6-2oaor,7o
]l PERMA?aEN~ A001iE55 FOR MARMKi Pl1RPO5ES AFTER TRAHSfER di DISCMARCiE ]2. SKaNATl/RE OF PERSON BEM~Ci TRANSFERREO OR pSCMARC+EO -
~ ~~5~' ~'N .
PT PISRC~ (9P LOC~) PL 331t5~ Y~
TVPEO NAME. ONAOE M'~O TITIf OF AUTNOft1ZMV0 OfFICER 3~. Of OfFICER A TO SIGN
I~AISS M• D0~1'TS H~J~ MI~C ~S3T t0 ~
Y~ L1~ M~t~OV~ [MTION o~ rNn ro~r u ro K . ARMED fORCEf Oi TNE INNTEO iTATEf
~,u~ so S40K 212 ~ 2351 Rcro~ of nu~~ ort ascw?ac~ 1
y
- , - . . _ _ _ - -
-~~s - _ ~.3.~:
_ ~Y :