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Te CHARACTER OF SEPAGATION . REPORT OF SEPARATION FROM THE ry DEPARTMENT if «.¢,HONORABLE = ARMED FORCES OF THE UNITED STATES TTT Litt NAME = FURST NAME = MIQOLE RARE Ta oo Sa ANO DATE}& 4, SHPONENT AND BRANCH OR BOOTON JOHN DON 17 292 092 c(t) 6 Aug “RA —Unase SEPARATION 1? TYPE OF SEPARATION scharge ’ 6 EFFEC abe sure AAT HUMBER OR SY hteo Lae LATED CIYLIAN OCCUPATION AND 9. 0. T. NUMBER ; Pye |G 730 ns on OL s at. 7 REASON ANG AQTHORITY FOR SEPARATION 9. PLACE OF SEPARATION US Disciplinary Barracks xpi p..Tar.of Se ce_AR 615-360 . for Mearenno PE... AAS DAT atic 11 PLACE horyd £8. and State) A DrscReticn SLO Pan eae a LESTIVE SERVICE LOCAL BORK, NUMBER on County, Beate) TROUSTCO +“ an MORTH AR: v MEANS OF ENTRY QOTKER THAN BY INDUCTION . Ta GRADE ~ RATE OR RANK AT TIME OF Ti REENLISTES INTO ACTIVE SERVICE 7} rcesusree as fe] emusreo fe) AND at 1 20, HOME ADDRESS AT TIME OF ENTRY INTO ACTIVE SERVICE (St, RAD, City. County and State) 205 W Prairie Street, Marion, Yallianson STATEMENTCOF., scevice FOR PAY PURPOSES ; eee aa BAYS Fe GRA RT ALLOWANCE PAID ON EXTENSION OF 1. ) SERVICE COMPLETED FOR PAY PURPOSES EXCLUOING THIS PERIOD YEAR | AMOUNT t 22, NEY SERVICE [22 NEY SERVICE COMPLETED FOR PAY PURPOSES TKS PERIOD | MPLETED FOR PAY PURPOSES TRIS PERIOD eS ee Pe 7 ‘ - 23. “OTHER SERVICE (Act of is June 80 as amended) COMPLETED FOR PAY PURPOSES Sia BR SNS RVICE rte AAP vrs CORAT TIONS, MEDALS, BABGTS. CONTENTIONS <7. ATG: NS AND CAMPAIGN ROOCRS AWARNIO SR AGTACRITD - n) Occupation Medal Ciapa UN Service Saat Korean Svc Medal ‘w/ 1 brz svc star Combat Infantry Badge AR 600-70 a ational. heh ens eas? rvice-Heda 29, WOUNDS RECEIVES AS A RESULT OF ACTION WITH ENEMY FORCES (Place and date, if Frown) 5025 aS US Disciplinary Barracks . ist Guard Company None 0 RVIRE SCHOOLS OF COLLEGES, COLL RAINING COUR ANG/OR + AUTT OM: 2 : POST-GRAD, COURS} JOSE COMP 9, From-Fo) ig material oer. Tn Per onnel mn un tobeuscd ¢., ord sseminate i bn the Bureau, its SEPARATION OATA TA SELECT: VE ALL ENTRES APPLY Tr CURRENT PERIOD OF SERVICE Cuniess ofherarse indicated} hay 29 hy GOVERNMENT INSURANCE (INFORMATION: (4) Permanent plan premium must continue ta be paid when due, or within 31 days thereafter, or insurance Will lapse ¢B) Term insurance not under waiver same ps (A) BOove, <C) Term insurance under waiver + premtum peyment must be resumed within 120 days gfter separation Forward premiums én NSLI to Veterans Administration Oistrect Office having jursdiction ovar the acea Shown (0 Ftert . Forward premiums on USCLI to Veterans Administration, Washengton 25, D. € (dee VA Pamphlet $3) When paying premiums give Tull name, address, Service Number. Policy Number(s}, Branch of Servics, date of ‘separation, Contact nearest VA office for information concerning Government Lie Insurance 36 TRAVEL OR MILEAGE ALLOWANCE INCLLUOED th TOTAL PAYMENT 38, REMARKS (Continue on reverse) No time lost under section 6{a) Appendix 2b HOM 1951. Item 3-Porm Grade Pvt E-2 Date of Renik 1 16 Fob 5. Blood Group "0" oe RAME, GRAGE AND TITLE (ypc) ’ ' L % FARDLOW WOJG USA | ASST ADJUTANT 4 ¥ BENEFITS PREVIOUSLY APPLIED FOR (Specefy typ SOMBER PENSION, INSURANCE BENEFITS, £1 . CLAIM NUMBER —— BATES OF CAST CIVILIAN ane 82, MAIN CIVILIAN OCCUPATION 43, NAME AND AOORESS OF LAST CIVILIAN EMPLOYER a "0 railer Truck Driver fe _—— p a pihhiage-aitioe ATES CITIZEN a5, c Age HOW SER TG (Yeark cteastolis Complete AIOR a : a7, PEAMAREN SADORES: FOR MAILING F: POs +h “ OTF We SIGRATERE OF PCRSO Bane E 3a HONE VORB 22 www thy BY arty wa ame hme SK ea mye fy 7 ivan 0 . ay Ld 03 “Fest Mdaros” Stes Me ~ Pieaaant, | . | | | q / Fe 5 COG i Pear - ] MAN AON RIERS: a Sonn, ‘PUIR FORCE: ATTACH TO SERVICE RECORD on" est «MY NAVAL PERSONNEL, ‘WASHINGTON, Di Oz DELTCRIAR Etat mye THAIS ANA HaRTNE CORPS™ DIS OR RETO MITE TO SRB OR OO amines to , - COAST GUARD; TO HQ. COAST GUARD, WASHINGTON. 2.6) DB Cooper 10271