IDENTIFICATION CAUTION: NOT TO PURPOSES BE USED FOR THIS IS AN SAFEGUARD IMPORTANT IT. RECORD. ANY ALTERATIONS RENDER IN SHADED FORM AREAS VOID

CERTIFICATE OF RELEASE OR DISCHARGE FROM ACTIVE DUTY i

j

This Report Contains Information Subject to the Privacy Act of 1974, As Amended. I

11. NAME

(Last First Middle)

T > _;- ·,

2. DEPARTMEl\lT, COMPONENT AND BRANCM ·t gc S fU J;f,X iliU,M '5 ' •i I !Yi )j .. .

, DA TEO; E t:f,; Mno;, 0 s6.;:1

/j 7a. PLACE OF ENTRY INTO ACTIVE DUTY b. HOME OF RECORD AT TIME OF ENTRY (City and state, or complete address if known) I COLUMBUS MEPS 4149 MAYST AR WAY

! GAHANNA, OH 113230 HILLIARD, OH 43026

Sa.LAST DUTY ASSIGNMENT AND MAJOR COMMAND b. STATION WHERE SEPARATED 1 STMARDIV29PI!v1EF NA VY PERSONNEL OFFICE TWENTYNINE PALMS CA 1! 9. COMMAND TO WHICM TRANSFERRED

10. SGLI COVERAGE NONE

ilcOMMANDER. NAVY PERSONNEL COMMAND PERS-912). MILLINGTON. TN 38055 AMOUNT: $400,000

13. DECORATIONS, MEDALS, BADGES, CITATIONS AND CAMPAIGN RIBBONS AWARDED OR AUTHORIZED (All periods of service) BRONZE ST AR MEDAL WITH COMBAT DISTINGUISHING

DEVICE, PURPLE HEART MEDAL, COMBAT ACTION RIBBON,

MERJTORlOUS UNIT COMMENDATION, GOOD CONDUCT

MEDAL, NATIONAL DEFENSE SERVICE MEDAL,

AFGHANISTAN CAMPAIGN MEDAL, GLOBAL WAR ON

TERRORISM SERVICE MEDALX X X X X

15a. COMMISSIONED THROUGH SERVICE ACADEMY

b. COMMISSiONED THROUGH ROTC SCHOLARSHIP (10 use Sec. 2107b) 14. MILITARY EDUCATION (Course title, number of weeks, and month and year completed)

BASIC MILITARY TRAINING, 08 WKS, MAY 09.

HOSPITAL CORPSMAN CLASS "A" SCHOOL, 16 WKS, SEP 09. X FIELD MEDICAL X X SERVICE X SCHOOL, X X 08 WKS, X JUN X 11. X X X X X X X X X X X X

X X X X X X X X X

X NO

X NO

& c. ENLISTED UNDER LOAN REPAYMENT PROGRAM (10 USC Chap. 109) (ff yes, years of commitment: I 16. DAYS ACCRUED LEAVE

X NO

PAID 0.5

17. MEMBER WAS PROVIDED COMPLETE DENTAL EXAMINATION AND ALL APPROPRIATE DENTAL SERVICES AND TREATMENT WITHIN 90 DAYS PRIOR TO SEPARATION

·jtt'.R .. 1AR}{S ., ? _;_. - 'f

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DO FORM 211..\ AUG 2009

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