◆ SpookStack

od me ' hl “ of, CK LF, RECORD—UNITED STATES an! hprtra crete eee fl et é ENLIST -— a4 1, LAST NAME@FIRST NAME=NIDOLE NAME 2. SERVICE NO, CODING COLUMN 3. SEX Booton, John Don | RAL? 292 092 | Male 4. HOME ADORESS (Number end atreet or rural route {if none, #0 atste), cliy, town or F, O,, county ond State) 905 W, Prairie 8t., Marion, Ill. a PT 5, PLACE OF ENLISTMENT $, ENLISTED IN THE GRADE OF | §t. Lonis, Mo, 4 7. ENLISTEO UNDER AUTHORITY OF GH OLOmLOG~L s APROGeG 6 BRANCH ENLISTED FOR™ SE 615012005; AFR 3904 r Corps of 9, FOR ASSIONMES(Y IN Toy TOTAL SEAVICE FOR O 4 ; — ne Oa None DECLARATION OF APPLICANT 13, COLOR EYES 14. COLOR HAIR —|-15, RACE cY | A 0, ) “BATE OF BIRTH Id, PLACE OF BIRTH (Cy ond State) 1 ' paY MONTH YEAR 22 Des 32 | Homer, Michigan Brown Brown White ‘| 4% CITIZEN 17. IF NATURALIZED OR DECLARANT, GIVE DATE, PLACE, AND COURT OF JURISOIC- 18, NATURALIZATION OR DECLARANT NO, | 1 [Bes Bro Hot applicable Nnot applicable \ (Craco pecuaration on j : 9, MARITAL STATUS a, NUMBER, AGE, AND RELATIONSHIP OF PEOPLE CEPR ARS ES rea ats, 0 4 gee ; 4, Single None fhins sy TAL HANDLING'REQUIRGh <f D “9! od fran wa dee , 21, EDUCATION (Years) 22, OTHER CIVRIAN SCHOOLS ATTENDER, (If depree, wate kind) “2 Ce che RIG iis. "1 "7 Seaman | tee se “é we ‘ #6 eel Geese aly. Donat “Msoourt) 8 2 0 None “, {sscninate in its orien. Oo not recopy qo ZA, CIVILIAN TRADE OR OCCUPATION (Fest qualified) , o LUT GILEONG EMPLOYED (¥reeud sao) ‘| Helper on truck : a 6 mos $40.00 2A, REGISTERED FOR SELECTIVE SERVICE 25, SELECTIVE SERVICE BOARD NUMBER AND ADDRESS (City, county, State) (2) ves, Numser £)xo o 25, PRIOR ROTG OR CADET TRAINING (Years-~Ty pe unit) 27 RESERVE COMMISSIONED STATUS (Br and erade new held, if ery) ‘ ' Hom 3 Sa) SERVKE (USA, USAP, USN, USMC, 2, COMPONENT (Reg, Fes, AUS, AFUS, FedNG, or St @) | 30, SERVICE NO, t RB one 3 $3, ORGANIZATION . . $2, TYPE AND DATE OF DISCHARGE 3%, IN GRADE OF MOS None eines Minnie elie M4, HAVE YOU EVER BEEN CONVICTED OF A FELONY OR ANY OTHER OFFENSE (ercluding plolationa of local ordinances)? IF SO, GIVE DETARS, (Previous scrvice- 11 men—enswer “No” unless convicted subsequent §¢ date of last discharge.) » a ae | . s . “ sy, 14 f t a Fy “4 ' Ho 4 7 35. HAVE YOU £VER BEEN IMPRISONED UNDER SENTENCE OF ANY COURTI FSO, GIVE DETANS,. (Precloud sercicemenmenswer “No” wnkas tuprisoncd |.) s } wudseguent to Late of last discharge) “ aatiee . H Ko 0 . 4 boo, 4 ' 1 _? tba . yo "y ww I ae Se oe %, ARE YOU NOW OR HAVE YOU EVER BEEN ON SUSPENDED SENTENCE, PAROLE, PROBATION, OR ARE YOU AWAITING FINAL ATION ON CHARGES AGAINST YOU? (Answer “yes or “no (Prevlots aerrlcemen~conaider only pertod aince date of Laat discharge.) \ : 3 . 37, KAYE YOU EVER PREVIOUSLY BEEN RIECTED FOR INDUCTION OR ENLISTMENT IN ANY OF THE ARMED FORCES OR HAVE YOU EVER BEEN DISCHARGED FROM A PREVIOUS ENLISTMENT OTHER THAN HONORABLY, OR BY REASON OF UNSUITABILITY OR UNDESIRABLE HABITS OR TRAITS OF CHARACTER, OF FOR MEDICAL REASONS? , . ’ Yo 2. HAVE YOU EVER HAD SPELLS OF UNCONSCIOUSNESS OR FAINTING, EPILEPSY, CONYULSIONS OR FITS, ENCEPHALITIS, NERVOUS TROUBLE OF ANY SORT, HAY FEVER, SINUS TROUSLE, RUN- NING EAR, EYE DISEASE OR INJURY, CHRONIC HEADACHES, MIGRAINE, TUBERCULOSIS, ASTHMA, FOOD OR POLLEN ALLERGY, DIABETES OR SUGAR IN URINE, BEO WETTING, VENEREAL OSSEASE, STOMACH OR QUODENAL ULCER, SCARLET FEVER, CHRONIC BACK PAIN, ARTHRITIS, RHEUMATISM, RHEUMATIC FEVER, HEART DISEASE, DROKEN BONES, DS TEO JOINTS. LOCKED KNELT HAVE YOU OR ANY MEMBEA DRL YOUR FAMILY BfEN TREATEC AT A HOSPITAL, ASYLUM. OF SANITARTUM FOR A NERVOUS OR MENTAL CONDITION OR OSEASE? VS. YOU EVER BCEN ADLACTED “ee TO ThE USE OF ALCOHOL, MARIUANA, FARCOTIC OR RABIT-FORMING DRUGS? HAVE YOU EVER HAD ANY MENSTRUAL, UTERINE, OVARIAN DISORDER, OR ANY es sgn OR MISCARRIAGES? Fa. ARE o Far of the foanaing Ue "yen,” ee dates end aliments whieh ennter Vj Ure addutionsd plein sheet of paper for da anes Left ‘Ara’ Broken 1968" * Ocoee Pe eT Mm AN ay — es ee ee Pop thaws ef DB Cooper-10274 i ' a Hay 3°. cha no. ‘ ‘ ‘ . ii ard - ' ’ py, CAA. ial 16--008554 ORIGINAL—MORNING REPORT COPY . Nee ay 48, which may be used. | DUPLICATE—SERVICE RECORD COPY ‘. a SAMA Replaces NME Forma 40M oe me