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CAUigN: NOi TO BE USED FOR THlS 13 AN le[L'ORTANT RBCORD ~
ANY ALTERATIONS IN SHADED
IDENTIFICATION PURPOSES SAFEGUARD 1T AREAS RENDER FORM VOtO
Oo FORM PREVIOUS EDRIONS OF THIS ROM ACTIVE OUTY ~ OR DISCHARGE
1 JUl 79 FORM ARE OBSOLETE.
t. NAME (LoM Jlir~M. s>,lIY4j 2. OF?ARTl~1EM. COM?OtrEPIT AND IMiwNCH 3. SKUMir NO.
PRICB CHIiIuT(PNNN CARL AIR F(RC$ RIB AF 1101E 84 1971
aa. GRADS GATE OR fAWT tb. ?AY GRADE S. OAiE OF 111RTH e. ?twCE OF ENTRr MRO ACTIVE DUTY
S1tA $k 1958 Oct 27 Jacksonville FL
7. uSi OU1Y ASSIGNMEM AND M/UOR COMMwNp R. STAf1pN WHERE SE?ARATED
31 AG TAC Homestead AFB FL
9.. COMMAND TO wHKH iRAPISfERREp 10. SGU COVEIGGE
USAFR wMatNT S 000 D NONE
11. ?RYAARY S?ECMLIY NtiMItER,lfilE ANO YEARS AND 12. RECORD OF SERVICE YEAR (s) MON OAY (a1
MONTHS RV SPECU1tiY (Addiionot speriatp numbers and tiles it DoN Erered AD llrb Period 1 6 21
wuofusgg penods o/ orre or more peQrs)
j La6250, Aircraft Armament S~rstems Specialist. °'s.v..alle.oei. TAb Perbd
3 years and 10 months. ` `~"'1dti s'r"I0''"" ?'r'od
j d. ioai /rior Adios Senrw
t Tool Prier Ieodine Ser+ke
I
C Fweye Ser.fu
F Seo Sente
f
>L Ewedi.. ooie d ?ey Grede J 01
L Reser.e ObYp. ierrw. Dole 1 ~ 0
t3. DECORATIONS, AtEDAIS, OADGES, CrtAi10NS ANO CAMYwIGN RR100NS AWARDED OR wUTHOR(Z!D {All periods o/ssrvior)
Air Force Good Conduct Medal (21 Jun 1976 through 20 Jun 1979). Air Force IAngevity
Service Ribbon.
11. MIIIIARr EDUCAiiON (Course 7tittr, number io[~aks, and month and year compTeieidj
Basic Military Training, 6 Neeks, Aug 1976. Professional Military Education Phase I
"Nonconnlissioned Officer Orientatiuu Course," 1 week, Nov 1979. ~teapons xechanic, 12
ilreeks, Oct 1976.
IS. MEtrItER CONTRR1Ui~ i0 POSi-VETNAM ERA 16 HIGH SCHOOL GRADUATE OR EOUN:.IENi I l_ DAYS ACCRUED
VETERANS' EDUCATIONAL ASSISTANCE TMIOGRAM DYES ®NO ®YES D NO lEl?vF iwD /G~if15
' le. REMART(s Not 8pplicable. J
s „wV~
190 NOV 20 !Ui 9~ 18
~ f'
5 ~
/
1?. M/l1IRrG ADDRESS Afi~ SFJARATION 20. MEMBER REOUESiS COIN 6 Of
{ ~ NOI'th Av+e ~ AFFArts~Drl YESH DNO
Fort Pierce PL 33450
21. Of MEALIER I~RiG SEIARAi~ 2L TY?EO NAME„ GRADf~ TrtIE AND NATURE Of OFf IC1At
AuTi1DRIZEDw ESI~3C 3. GR'8N3~IiW, ZLt, USAF
~ ~JAISTY FC'~tCE S:E~TZOid '
_ ~ ~ , ~ ~ _ MEMQER 1 l„