HomeMy WebLinkAbout0016 , i..
~
, •
r
f
}
~i -
` _ , ~~J. . ° .
4~~~ ~~c '
- . iNlf If AN IMrOR?ANT ~ECORD _
fIIFEGUAtO IT.
i. LAST NAME - i1~ST MAME - YIDDLE NAYE 2- SEt SOCIAL SECURIT~ MUY~E! l. rEAR YONTX OAt -
DATE Oi ,
itRTN
5. OE~ARTYENT, COMrW1EMT ANO tRANCN OR Cl 55 ~O- GRADE. RATE OR RANK 6.6RAOE ~EAR 110MTN ~ DAt .
~ATE OF
' wArR
SELECTIYE SERYICE NUMlER 6.SflECT1VE SERYICE LOCAL WARO NUM~ER. CIT1I, STAiE ' t- HOME Of ~ECORD AT TIYE Of ENTR~ IMTO ACTIYE '
AND 21~ COOE SE~YICE lStrtN. RFQ Ciry, Srme and ZIP Code/
30 FZameside Ave ~
9a. T~rE OF SEfAtA710M ~ b. STATION OR ~MST: iUT10M AT MfNtCM EifECTEO
J 2
C. AUTMORITT AMO lEASON d. fEAR MOMTM DA~,
tr~tnve 29
DATE 7S ~
e. CMII~ACTER OF SE~YICE TY?E Oi CERTIi1CATE ISSYED t0, tEENIISTYENT CODE .
NA
11. LAST OUit A551GMtENT AND MAIOR COMYAND ~ ~ 12. COYYANO TO WNICM TRANSfERREO ~
~~~~yg(; ~Q~..~NR JA~INC 28545 as Ci MJ
13. TEAYIN~L D11TE Of RESERVE/ I~~ ~~ACE Oi ENTR~ INTO CUWAEIIT ACTIVE SERVICE /Ci(r, Slcte and Z/P Codt/ 15. D11TE fNTERED ACTIYE
MSS O~IfGATtON ~ DUT~ TNIS ?E11W0
~EAR MONTN OAr . tEAR MOMTN OAf '
80 09 29 MIiS Ha~ tford GT 1~7C 950 _ _ 74 09 30
~Su PRIMARY SPECULTY NUYBER b. REU7E0 CIVIUAM OCGUPATION AND 1!. -
~ AND TITIE ~ O.O.T. MUMYER NECORD Oi SERVICE ~ TERRS YONTMS DATS ~
tf/ C S~ 1'CC31 tflll:idl6 ~Ld ~ l'C(11 !a/ MET ACTrvE SERYICE TNIS PENIOD _
(6) fR10R ACTIYE SENYICE _
i
~ « SE~~!.•:DANt SYECIALTr \UMlEfI RELATCO UYI! IAN OCCUPATfON AND T~TAL ACTIVE SERVICE (a ~ GI
• AND TITLE O.O.T. YUYpE^
~ /d/ ?RIOR IMACTIYE SERYICE
~ *T~e IPI ~ iOTAL SERVICE iOR ~At (i' *dI
1Rd1 1RJ1lC
E _ I/I fORE1GN ANDiOR SEl1 SERVICE iNiS ~EN~OD _ 27_
i
,~y. 1Ap~C~.~NA OR KOMlA S[RY~CE S:ntE AuGUST 5. i~64 20- NIGNEiT EDUCAIWN LEVE~ SULCESSFULLT COM?LETED //rt Yeais/
~ ~ TES ~ NO • SECONGAR~/HIGX SCNOOI ~ tP5 ~l-ll4rad.r/ COILEGE _ tR5
?t *~KE ~OSi!J'iece.i.nK Tw-o 2=. C~6'!S ACCiIUED 23 SENV~CEdE4~5 GROUD UfE 2~. DIS11BillT'/ SEVERANCE V11T 25. Cf45CNNEL SECUNIT? INVESTIGATION
)is/ IEAVE PA'D INSURI1hCE COYERAGE .
515,000~ ~D t5,000 ~ NO O ~ES a' T~~E 6. DATE COY?LETEO
Norie 38.5 days ~20,000 .
510,000 ~NQNE AYOUNT ~~A ~~ii~[~]v 7411W
c6. CECORATIOMS. MEDALS. SADGES. COYMEN011TION5. CITAilONS AND CAMPAIGN AIBBONS AWAYDEO OR AUiNONIZfD
F~q~erC Rifle Badge M-16 ~
Good Co~Zduct Medal
27. NEYAYKS
Maaciee requ~ests his copy of D~D Form 214 (MC) (1'~
1~ M
cood cond~ct r4eaal reri.od oom~noes 770930 ;;9 -6 A,k 37
- F I~EU AhU hECUkt~_u
~ ' s ROGER
PO
YRAS~.
~ CLERK GlRCUI~COU
~ F.,.CC~U iERlf!`~
~ /~~n ~p~y
~ `.tJVifrC7 ! ~
~
~
~ 2E. MAIIING ADC~ESS AfTER SE~AiATtON /Slre[t. RFD. Cilr. COUnly. Sfate, Z/PI 2~. SIGNATURE OF ?E~SON /EIM6 SE?ANATEO ~
4574 riorrth East Aig~a~n eircie %~,`cf~~ .%Y~~R.~a~y 1
10. TT~EO MAYE. GRAOE ANO TITIE Of AUTIIORI 11. 51GMATYRE OF Oii1C AUiM6~IZED TO SIGN I
~ ~ - ~
~ i~' L_
FONM pREV10U5 EOiT10N5 Oi~TN15 THIS If AM IM/O~TANT RfCO~D REPORT OF SEPARATION
DD , No~ ~z2 i 4 MC FoRM wAe oeso~crc. . s~FECU~RO ~r. FROM ACTIVE DUTY (1900) INDrv
S/ N 0 t 02-002-000 t
- - - . _...-__z..~,-s: