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![I CaUITON NOT IO aE USED FOr
i IDENIIFICATION PURPOSES
THIS IS AN IMPORTANT RECORD
SAFECUARD tT
ANY ALIERATIONS IN SHADED
AREAS RENOER FORM VOID
Illl :3t|, 214
PREVIOUS EDI]IONS OF IHIS
FORM ARE OBSOtEIE,
CERIIFICATE OF RETEASE OR DISCHARGE
FROM ACTIVE DUTY
S$&ffii"ff&lfif;rd a.o{rgp
2, D;?ARIMENT, COMPONENI AND SRANCH
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3. 50CrA( StCURtIY NO
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t 8?
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r 1 JUL ti5
6 Pl'ACE OF ENIRY INTO ACTIVE DUTY
Jrcrg0e,t&LE, FL
7. L,A5I DUIY ASSIGNMENT ANO MAJOR COMMAND
itt$ E08EE CS-30, Saa O1e6o, CI
8. STAIION WHERE SEPARAIED
lJ88 SEXE C6-J0, Saa D1ago, Cl
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9. COMMANO TO WHICH IRANSFERRED
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)0 SGUCOVERaGE
-^
AMouNr, il, ooo [-l"o*
I I, PRIMARY SPECIATTY NUMEER, II]LE AND YEATS AND
MoNIHS rN spEClAtTy (Addilioflal specinlty numbers and titlcs
inuoluing period.s ol one or more years)
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5P0-558 FLre ilrratrol E&dsr
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EGS DD214
- 1. I CaUITON NOTIO aE USED FOr i IDENIIFICATION PURPOSES THIS IS AN IMPORTANT RECORD SAFECUARD tT ANY ALIERATIONS IN SHADED AREAS RENOER FORM VOID Illl :3t|, 214 PREVIOUS EDI]IONS OF IHIS FORM ARE OBSOtEIE, CERIIFICATE OF RETEASE OR DISCHARGE FROM ACTIVE DUTY S$&ffii"ff&lfif;rd a.o{rgp 2, D;?ARIMENT, COMPONENI AND SRANCH Xer:r - ttsI i 3. 50CrA( StCURtIY NO . 265 t 8? t 6049 .a.fdaDE. tAr€ oR RANX 4b. PAY GRADE E-5 5, DAIE OF BIRT!"I r 1 JUL ti5 6 Pl'ACE OF ENIRY INTO ACTIVE DUTY Jrcrg0e,t&LE, FL 7. L,A5I DUIY ASSIGNMENT ANO MAJOR COMMAND itt$ E08EE CS-30, Saa O1e6o, CI 8. STAIION WHERE SEPARAIED lJ88 SEXE C6-J0, Saa D1ago, Cl CEXTEB HEI 0illg.if,"*S Il ?01{9 9. COMMANO TO WHICH IRANSFERRED ti.tYtl, flr.sEnYE Pr-&Si]flSEL )0 SGUCOVERaGE -^ AMouNr, il, ooo [-l"o* I I, PRIMARY SPECIATTY NUMEER, II]LE AND YEATS AND MoNIHS rN spEClAtTy (Addilioflal specinlty numbers and titlcs inuoluing period.s ol one or more years) rc-1 163 5P0-558 FLre ilrratrol E&dsr Techn; clen x I .t I I 2, R€CORD OF SERVICE YEAR fs) MON TS' oav (s,) a. Dotc Enlered AD Ihlr Pc.lod o5 Ufj{t u( b. Seoorotlon Dote Thl! P6rtod 9i9 lrglr rre c. N.l Aclivo Sgrvi<. Ihl! Poriod rr? 1t1' itt d, Iotol P'io. Actlve SerYr(o YI' v*, UU e, lolol Prior lno(llYe 5.rYI(6 I,e tt urJ l. Foreign Ser"ice tt tE, EO 8. Seo Seti< !t{ II t, h. Elleclivc Dolo ol Poy G.od6 at BET le l. Rcrc,re Obliq. Iarm. Dote o, uts; rJo r3.IEElXPNSREDIE[bllili cEpfdfuf E&tlfwARDEDoRaurloRrzED (Attperiods,,lseiibel . fea scrrlec Doplofurat'-r1bborl-r'rum[-6ooc oondu6lt for p*rlod Edleg 06 DEC$gr IXIXIIIIIITIII II, IIIIXIXIIXI,X ld. MILIIARY EDUCAIIoN (Course Titb, qumber weehs, and, month anil year ciompletedl BeeE scor, 10 reclcr, lpr 8{1 Flra codtrslr'Tabalclan clacg &4, SfO-55,5 CSF, e6FB t-lgt-$tg?, 3S ro.kr, Oat 65r iA' S€hool, a6 Ha€*a, Iov I5. MEMSER CONIRIBUIEO IO POSI.VIEINAM ERA VEIERANS' EDUCA!IONAI, ASSISIANCE PROGRAM NO tr YES g 'I6, I-]IGH SCHOOI. GRAOUAIE OR EOUIVAI,ENI Fl ,r, fl "o I 7. DAYS ACCRUED I.EAVE PAID I8. REMARKS rtedleal Bnd Btatal Trrortroat Cagletedt DISTID$trffi or Do al{ Ilr [rgtrIl.ptft]soilIrff 1900. t TIII IIII t I x I x, I I I I I I I I I I I X I I I I I I I I I I '"$!.BUlM6*&flArA,oN Pqffi &rrc8, rL 3est, 20. ME}'BER REQUESIS COPI 6 BE SENI IO DN. OF VEI aFF^rRs- l--lr* I-f *o 22. wPED NAME, GtaDE, rmtan6 sloxrrure or oirrffi AUIHORTZEOTOSTCX &t- .fJ-J*{.d-,p t g $Ptrr68&, rcg, ,ffi- gr BxxBrIfi SPECIAT AOD'NONAL rnaF()ltlltqN (Foruu O! a$Iertd o^a) 23. IYPE oF sEpArAIoN BAlm*A ftre letltllr dnty rnd tmacfor to f,avrI f,sssrre 24. CHARACIETOF *gvtcE (h*tfu ,tpgtda) EOTO*TEI.E 25. sEPAFAIION AUIHORTTY xlltE58ilfi 1680t60 2'. sEPATAIION COOC ff 17. lEr{usilffENlcoDE ln-Ii ln NARTATIVE IEASON FOT SEPATAIION &rytrattoa ol tcrr of, Eqllatrrut 29 D^IEs OF IIME I.OSI DUPING IHIS PERIOO 'tx.'+QflE. rc'MEr'EEtWNrr ts*- s/N o r 02.rF-ooo.2T4o