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2. CERTIFICATE OF RELEASE OR DISCHARGE FROM ACTIVE DUTY
This Report Contains lnformation Subject to the Privacy Act of 1974, As Amended.
1. NAME (La$, Fnsl, Middte)
HENOLD, ROBERT CHARLES
2. DEPARTMENT, COMPONENT AND BRANCH
ARMY/RA
3. SOCTAI
286 I
SECURITY NUMBER
e0 | 171s
4a. GR^ADE, RATE OR RANK
PV2
b. PAYGRADE
802
5. DATE OF BIRTH (YYYYMMDD)
L98812r4
6. RESERVE OBLIGATION TERMINATION DATE
(YYYYMMDD) 00000000
7a. PLACE OF ENTRY INTO ACTIVE DUTY
CLEVELAND, OHIO
or camplete address if known)b. HOME OF REGORD AT TIME OF ENTRY (City and state,
5600 ALEXIS RD APT 354
SYLVANIA OHIO 43560-OOOO
8a,
CO
LAST DUTY ASSIGNMENT AND MAJOR COMMAND
B 187 ORDNANCE BN T TC
b. STATION WHERE SEPARATED
FORT JACKSON, SC 29207
9. COMMAND TO WHICH TRANSFERRED
J/A
10. SGLI COVERAGEI I NoNE
AMOUNT: $ 400, 000.00
1 1. PRIMARY SPECIALTY (List number, title and years and months in
specialty. List additianal specialty numbers and titles involving periods of
one or mare years.)
NONE//NOTHING FOLLOWS
12. RECORD OF SERVICE YEAR(S) MONTH(S} oAY(S)
a. DATE ENTERED AO THIS PERIOD 20rt) rl_ 09
b. SEPARATION DATE THIS PERIOD 2 011 09 02
c. NET ACTIVE SERVICE THIS PERIOD 0000 u9 24
d. TOTAL PRIOR ACTIVE SERVICE 0000 00 00
e. TOTAL PRIOR INACTIVE SERVICE 0000 00 00
f. FOREIGN SERVICE 0000 00 00
q. SEA SERVICE 0000 00 00
h. INITIAL ENTRY TRAINING UUUU 09 24
i. EFFECTIVE DATE OF PAY GRADE 2U L-L U5
13. DECORATIONS, MEDALS, BADGES, CITATIONS AND CAMPAIGN
RIBBONS AWARDED OR AUTHORIZEO (Att periods of sevice)
NATIONAL DEFENSE SERVICE MEDAL//NOTHING
FOLLOWS
14. MILITARY EDUCATION (Course title, numberof weeks, and month and
year completed)
COMBAT LIFE SAVERS CRS, 1 WEEK, 2OTA//
NOTHING FOLLOWS
15a. COMMISSIONED THROUGH SERVICEACADEMY YES X NO
b. coMMtsstoNED THRoUGH ROTC SCHOLARSHIP r70 USC Sec. 2107b) YES X NO
c. ENLTSTED UNDER LOAN REPAYMENT PROGRAM (10 USC Chap. 109) (lf Yes, years af commitmenf; NA ) YES X NO
16. DAYS ACCRUED LEAVE
PAID O
17. MEMBER WAS PROVIDED COMPLETE DENTAL EXAMINATION AND ALL APPROPRIATE
DENTAL SERVICES AND TREATMENT WITHIN 90 DAYS PRIOR TO SEPARATION
YES NO
X
18. REMARKS / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
BLOCK 6, PERIOD OF DELAYED ENTRY PROGRAM: 20100609-20101108//MEMBER HAS NOT COMPLETED
FIRST FULL TERM OF SERV]CEI/SM HAS COMPLETED BASIC COMBAT TRA]NING////NOTHING FOLLOWS
The information contained herein is subject to computer matching within the Department of Defense or with any other affected Federal or non-Federal agency for verilicatior
purposes and to determine eligibility for, and/or continued compliance with, the requirements of a Federal benefit program.
19a. MAILING ADDRESS AFTER SEPARAfION (tnctude ztP Code)
L5O7 HAGLEY ROAD
TrlT.Fn.)
^E-l.]'
A2.A1t
b. NEAREST RELATIVE (Name and address - include ZIP Code)
TINA HENOLD
1507 HAGLEY ROAD
.r'nr.E n.] nrJT^ a 2 41 ,
20. MEMBER REQUESTS COPY 6 BE SENT TO (specify state/tocatity) OH OFFICE OF VETERANS AFFAIRS I X lves NO
A. MEMBER REQUESTS COPY 3 BE SENT TO THE CENTRAL OFFICE OF THE DEPARTMENT OF VETERANS AFFAIRS
(WASHINGTON. DC} YESI X NO
21.a. MEMBER SIGNATURt
ESIGNED BY: HENOLD.ROBER
T.CHARLES.I399962206
p.uAttr
(YYYYMMDD)
20LL0902
22.a. OFFICIAL AUTHORIZED TO SIGN (Typed name, grade, title, signature)
ISIGNED BY: GUMBS.CIIARMAINE .C.LL8I295097
]HARMATNFI C GI]MBS. GSO7. TRANSTTTON SIIPF]RVTS
P.UAIE
(YYYYMMDD)
201L0902
CAUTION: NOT TO BE USED FOR
IDENTIFICATION PURPOSES
THIS IS AN IMPORTANT RECORD.
SAFEGUARD IT.
PREVIOUS EDITION IS OBSOLETE.
GENERATED BY TRANSPROC
ANY ALTERATIONS IN SHADED AREAS
RENDER FORM VOID
SPECIAL ADDITIONAL INFORMATION (For use bV authorized aqencies onlv)
23. TYPE OF SEPARATION
)ISCHARGE
24. CHARACTER OF SERVICE (lnctude upgrades)
HONORABLE
25. SEPARATION AUTHORITY
R 635-200, CHAP 13
26. SEPARATION CODE
rl nLl
27. REENTRY CODE
3
28. NARRATIVE REASON FOR SEPARATION
JNSATI SFACTORY PERFORMANCE
29. DATES OF TIME LOST DURING THIS PERIOD (YYYYMMDD)
TONE
30. MEMBER REQUESTS COPY 4
(/nlfialg RCH
DD FORM 214, AUG 2OO9 MEMBER - 4