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CAUTION: NO1 iQ_EE U3E4 FOR - TH1i 1f AN 1lttORTANT R~COfD , , ANY AUERA1tONS IN SMACED
IOENrIF AiWtV FiIIlPOSES ~ QAtlDOUARD IT " - ~ ~ AREAS RENDER FORM VOID
fOR1R ~ laevlpus EDIrioNS OF ilils CERTIFICATE CF RELEASE OR OKCHAROE
• ~~~~`•'t JU4il~:'~.Z~4 ~ FORM ARE OBSOIEIE. FROM ACTIVE DYTY
. iHAMI! 2. OE?ARTMENI, COMiONEN1 AND BRANCH `
ROW3B Ztiooa~ Chnisto bar ~ ~ USMC-il- ~ ~ 0
iR. 9ADE. RAt[ OR RAN11• _ a P_
AY S. OAiE OF eiRiH KACE OF ENTRY INFO ACTNE DUTY '
MB t.' R-8~ 410523 Lon• Island NY
7. IAS10UlY SSiGNMENi AND MAIOR COMMAND STATION WHERE SEIARAtED RU(`, 11104 •
H Co 1stMar•1stMarDiv CamPen CA 92055 N Co 1stMar 1stMarDiv CalmPen CA _
9.cOMMAND1oWNICHTRANSFERRED 'Marine Corps Reserve Forces lo. SGUCOVERAcE
Administrative Center MCRFAC Kansas Cit Missouri AMOUNit NONE
11. PRwANY ~?ECNl1Y NUMRER,11TlE AND YEARS AND 12: RKCMlD OF SERVICE YEAR (s MON DAY
MONTHS w s?ECUUr (A~o~ eil•~+a+y and
olvobi{ePeriods o/ows or neon years) a. Doe. E•4.•d Ao tAM ?•.ae .
a S.V•rMion Osh 7M+ Pa1od 1
2537 -Radio Chief N.I Adhr. s.r•k• rAl,?.rbd .
(12 yrs, 11 tilOS) d Tavel?rNr AdN~ S.r.k~
8411 -Recruiter _ a Tool hl« hedl.. S.r.k. ~ •
(O8 yrS, O1 mo) L Fw.ynS~nk• '
i• Ss• S~r.w '
• L R.Hr•• ONq. i.ra~. OoN .
13. DECORATIONS. MEDALS, BADGES, CrtATgNS AND CAMVAIGN R6BONS AWARDED OR AUTHORED (All perbds o/isrvkY)
Vietnam~Service Medal (w/2*), Navy Unit Coi»mendation, National Defense Service Medal,
Republic of Vietnam Campaign Medal (w/1960-), Presidential Unit Citation,
Republic of Vietnam Cross of Gallantry (w/palm ~ frame), Navy Achievement Medal (w/"V"
Combat Action Ribbon Good Conduct. Medal w 5* Rifle Ex ert Bad e- 4t A d ~ -
11. MILITARY EDUCATION (Coaret 7Yt1e; numbtr sveeRs, and mon/A an$ year completed)
None - '
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1S. MEMBER CONTRIBUTE TO VOSi-VrtiNAM ERA I6. HIGH SCHOOL GRADUATE OR EOUNAIENT 17.}D~A(YSF~ACCRUED
VETERANS' EDUCATIONAL ASSISTANCE iROGRAM ~ YES ®NO ®rES ~ NO RLISV i?~~S SLB 0
IB. REMARKS •
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Good Conduct Medal period commences: 771217
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Iteta 13 con't: Pistol Expert Badge (4th Axd), ~ _ - -
f _ .
~ Extended Enlistment: 791023 (08 taonths) , "Extension of service t~tas at the request '
and for the cotxirenience of the Govertm~etnt." .
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TY_ MARRVG AD6sIEii AFTER SEMRAiION 20. A{E~ARER IiEOUESiS colt a RE
477 S.W. Kentwood Rd. - sE++rio• _Fy_oM. of vEi
-Port St. Lucie, FL 33452 ~ ~ S HO
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F1lEG AIiO RrCOR0E0
ST.lUC1E COUNtY.F``A. ~
ROGER POITRAS
CLERK CIRCUIT C ~
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