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TNFS /S AN /XlORr.INT RECORD i f
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1. U?St NMIE-F)ILST wuEE-~rootE rwEE t sEnncE NueER a. sacu~ sECwn /wER
o OR CUSS _ Sa GRADE. HATE 011 RANK • PITY 0. OAr i
GRIIOC Oi I
RANK e
U. S 0. RACE a BrtM (CIry of SHN r Carr? ~ 9, DAT
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!l~--~, IOa SELECTIVE s[Rrltt NRNRIEA ? SELECTIVE SERVICE LOCAL BOARD NIRIBER C1T7tt COUIFTr. STATE AND LP CODE c - DATE MOULTED
- wr 110NTN i
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11a Oi iRAFRFER OR 019L11ARGE • STATIOIF OR II4TALLATION AT VT111p1 EFFECTED ~ ~ -
S
c REASON AND A1i1110RITY EFFECTIVE r
bF ~ ~ OATE ~
li ollr ASSIDT.~/FT AIO IMI(>j100L.1A1O 13a CNARACIER a SERVILE ? TYPE OF CERrIE1G1TE EiSiRD
Il .AREA oR TO rngl IS. R[Ei1IriT1EM OODE t
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10. SERVE 1). CURRENT SERVICE 8r MOIICfION k TERM OF c p•TE Oi fMRr ~ .
IRiT i s OBUG11igN a SOIMILE Oi ENTRr: SERVILE
DAr MOIITN TEAR ~ ERLSTED (rrr rairaet0 a ENUSTEO (hl« Srw~rl O REErIiSTED (Ir'I wr TN ~
- OTHER - - ' i
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l0. PRIOR REGULAR ENUSTYEIITS I9 GRADE.MO ~ ~T ~ m. PUCE OF ENTRr INTO CURREJIT ACTNE SERVICE (Cq w1 S.w /
2l. 11011E RE AT TRIE Of ENTRY MO ACTIVE SERVILE >7 STATEIENT OF SERVICE rEMS 110NTIIS DAYS
/Swrc RfQ CIry. Cary. Sarv ZFI fril
~I a (1) NET SfRrltE THS PER10D 'j
FOR~e
vc~PAr Et/ otNER SERVICE {
z3a r a l D.OT N(~ oCC(IWITION AND F1rR~3 (31 TOTAL liar IF?/lo trr ln1
• TOTAL ACTNE SERVCE
r Y~~~ c FOREIGN AIO,OR SEA sERr~CE
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~ 2A. DEOORILTIONS. DALS. BADGES. OOWIENOIITIONS CITATONS AND CAMPAMiN ROBONS AYWIROED OR AUTHORIZE6 .
A 43"35
Mat Dot Mil.
sEDI~ AF~'RA~N~ 1 ~ JU. Z3 PM I~ 31
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Xr NON PAr PER1006/TIME L06T (I.arrir ~ • OArS ACCRUED LEAVE PAID 2ra MFSLIRANLE N FORCE • Al10UNT aF ALLOTIENT - c IFONTII ALLOTIEIR
r.. ra..? (xsu r asccr? olsoDFlTruEo
Y~W ~ rES ~ NO f
~ tj ~ 28. YA CIAY 19. SERVV;EMEN5 GROUP lME RIS(1RANCE
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1 G ? S10AOD aS.00D ~ NONE .
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as REMARKS
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31. F4Rl1AIRNT ADDRESS FOR MARJIG PUM'06E5 AFTER TRAF4fER oR DWDI(ARGE 3L SIGFIAT(IRE a PERSON BEING TRANSFERRED OA OKLINRGED
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N 214 MC (1900) MtVFOUS twTaNS or A11ME0 FCMN:[D OP' TN[ YRIT[D iTAT I1~~1EE~~'v_
s TNIS Powr A.R o.MO~RrR Rt/0117 0/ TRAilfi[R OR dsc S/N 0102402-0000
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