Service-Member Serial: 

Registered for Draft: 

Enlistment Date: 

Enlistment Location: 

Terms of Enlistment: 

Branch of Service: 

Military Occupation: 

Enlistment Physical Description: 

Prior Occupation: 

Race/Ethnicity: 

Marital Status: 

Number of Dependents: 

Height: 

Build: 

Weight: 

Eye Color: 

Hair Color: 

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Service Remarks: 

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Recipient of:

- 

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Rank at Separation: Private First Class (Pfc)

Separation Date: 

Separation Location: 

Condition of Separation: 

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Birth: 

Death: 

Burial: