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. LELP\Dr lnsat \~A ts f!t itt~s ~tf~ waiN s~ , ~ite 2'~19~9' ~ 1, LA57 NAhl~-itR~T iMt~- uODLE NA?+E 2. SERViGE !flMe7E.q 3y. GMOE, MTE 0!t RANK b. OATE OR RA::!:/P)ty, !lo~tl, ~ ~ w~Ee ~ a r.~ . < . DEPARTWEI~R. CCMPON~NT /U~Q BRI?NCM 5. PLACE OF H1RTN (tity..d ;"erKr w Cai~rsy~ OATE ~V M~yNTN VEAR t . i ~ ~ ~ ~ i`~~ 81~M zo 7a. b. SEX C. GOLOR MAIR d. GOIOR EY£S HEtGNT J, W:i~:l+T 9. U.S. GiT12EN 9. t,sARtTAL STATLiS a ~ ' ` ~ S Q H8 W 0. f0a. HIGHEST CIVILfAN EOtJG71pN t„EVE~ b. MAJOR COURSE OR iIELD A~TAINEO ~ t fa. TYVE OF TRANSFER pR DISGHAFiGE 8. STA::OAi QN SNST1t;.U1TS{kt R' Vlfit~GH EFfEGTEO p0 ~ir! ~ ~ ~ ac c. RFJ~SON A!A A~TMqtITV w~ .EFiEG DA Ma,yTH YEAq x~ ~ ~ ~ ~ ~ rr~TE . , t~ 12. LAST OiJTY ASSIGk~ENT wND NNJ~t COrMM1O - 13u. C++ARAGTER QF SE~tV:C£ . b. TYPE OF CERtIFICA~£ • ' ~sse,ea o ~ . ~ 1~. SEiECTIVE SEtN~CE NUMBER 15. SEIECTIVE SHRVICE LOCAL BOAAD N;t~R9ER, Cl~v, GpUNTV AND 3TATE iP~. CATE IND'JGTED ~ jb ^AY MONTH YEAR ~~F ~ R u~c< yp~ 17. DISTRIGT OR AREA COM.UINO TO W~IGH RESERV:ST TRANSFERRED q 19_ TERMit!!: ^~ATE C!i ItESEpVE 19. GUkRENT AGTIVE 3EFNICE OTt~ER THAN 8Y 1NDlrGTSa?i , TERM Of C, OATE OF ENTRY . IGATI~l1 A. SOiJRCE OF EHTRY SERVICE DAY MOMTN ~R ENLISTED IFirst 6~fist~e~~)~ENi.I5TEOIP»~+ Sen~~ce)~A~QNLIST fYeoaj flAY MOMTM YE/1R Q OTHER: 20. PR(QR REG EHLIST(~NTS 1, GRkQE, RATE OR RAlVli M TtYE Of 22, F~/?CE C3f EkTitY }tii0 CURREtiT ACTiVE SERYIGE1Cety o¦/ Statel ENTIIY INTO C13NRENT ACTIYE SENYICfr ~ ~ 23. FlGME OF RELpRD AT TIME OF ENiRV INTO AC71VE SERVICEISi.~rt. RFD 24. STATEMEHT OF SERy!G£ YFJIRS 1XJNTHS DAYS ~ G~ey. Gotnt_ Y aad Smte~~ 4• ~I11 NET SERViGE TM~o P4Rt~ , ~ ~ ~ ~!iE0!TABLE su++ BwSiG i21 OTteER SERVlGE , SQ.SPECIALTYNUMBERANDTITLE b. REUITED CiVIL{AN OGCl,7AT30~ An0 p~pApSES {31 TOTAL (LeRe (I)f' /tn! (~7 ~ < ~ O. O. T. Nl:~IbER ~ o i ~~~j ~ 8. 73T/~L ACTIVC 3[RVtCE i V ~R ~ c. FCPEiGY AND%Ofi SEI S£itVfGE { ~ ~ 26. DECOFiAT~ai3, MEOAl.S, BADG£S, CU`/!:J£FiQAT1~J.Y5, CITATIONS ~kD Gl!AAAiuN Rt93?HS AW r 12E'J i 4 t ~ p ~ EJ(PE1Cf (It1iLE N~-t~~ , . ~ 27. WOtNiDS RECEIVED AS A AESULT 0° AtT1pH WsTN ENE.~Y FORCES ~Pfacc a.+d ~atr. ~r ~ncn-W e ~ 2t. SE Ot COlifGfS. C6! LEtif iRA+i~Yi ~OLtSEi ~NO:O[ iOSiGiAOUATE CO~~~SEi S;Y::~Sf::LLY CC~-'°1:E6 - ~ 24.QT~cR SERVICE TRA~NING ~ i SCHOOI. OR GOUic~e e~iES SF~w- Tol ^T ?M37A ~AuRScS C~.%pSES SUGCESSFtlLLY € Q b ~ t ::.tP.ETED i I ~ i ~ ~vc s v~s t l ~Y ~ ~ ' : ~~s~ ~ . 304, G4V~~r: AENT l1FE fN51;itANCE IN fGRG~ i o A~~i~*T vF A:.~~CTM£NT . G~?~Gl~tH ALIOTMENT ~ - ~bM~iNUEO r ~ YES Q NO i - - - - _ ` ~ ~ ` 31Q. VA BENEFITS PREVtOUSLY AqPL~EO F (S~ecily ,/~,M1~~-- ~ , . E CQ ~ Y u4:~n.•~eER _ ' CER P01 A t i _ I ^ 32. s RfCORG VER~Ft~Q - , ~ ~ ~ ~1~ i~R~01! s '.A" ~ . . ~ _ - { ; . o ssru~ ~t?t ,6 o~s ,~M l ~ P~I'Z~I . - . - - - i i 3 < ~ ~a. ~.wc ..i. tK kf ~ra aoc.v~d ~ _ _ ; i.~- 1 ; . , ~ ~ Z3 +Irys tas t tsas 1 D 11wr-Z pa~s 6$ _ _ , ' = Y lt~s 33= :Sh M~r~i~ fi2cA ftna~t, ~htla~i~lpA~a ~l~# ~ ~~~Il~t~ = a i ; i 33. t AFT~R TRANSr-ER OR ' 34. gi~hAT':; 0.° 7ERSJli 3E:~f3;r AAEQ QR ~iSC!U1RGE0 DISGHAAGE lSArt?. RFA. Ci~y. Cowty a+af St~~~) ~ ~ 1 ' ~ ~ ~ y ~ i ~ 54. 0 . GR!?OE Av6 ttTLE Of' AtiZHCR!I~k^v GFFitER b. S:GWITiJRf 3!!J~tCER AtlTM,'JR7ZE S+:!1 ~ F r : s+r„i~"~'_.'7`: - - ; v _ s~"'"`-~- ~ % ~ - j i s`:J = . ` DD f F~~=~ ~id s voso~E~n.~~~~~ oc ! JUt S, WH~Ch ARirtEO F~RCES OF T11LT Jtil?EO 5TA?F5 RE~ORT DF TRAHSF£R Oft OISCNAR:,L- ~ r,,, s - - z - - .L. ~~w ~ ~ " . - - - s~~.