Honorable Completion of Term

1. AiIY ATTERATIONS SHADED
til
RECORO.
THIS ri AN IMPORTANT
CAUTIOil: NOT TO 8E U5ED FOR
FORMVOID
AREASRENOER
IT.
SAFEGUARD
ID E NTI F I C A T I O T IP U R P O S E S
d#{ELEASE OR DISCHARGERSM ACTIVE DUTY
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CERTIFICATE
NO.
SE€URITY
3. SOCIAL.
2. D E P A R TME N T,C OMP ON E N T A N D B R A N C H
1. NAME (Lart, First, Middle)
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SCOTT AI-LAN
LA}fBERTUS,
5. DATE OF EIRTH(YYMMDD) TERM.DATE
6. RESERVE OBLIG.
4 .b - PAY GRADE
4.a. G RA D E , R A T E O R R A N K
Y e a r( i Montif A I'I Daylr
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7.b. HOME OF RECORD TIME OF ENTRY
AT GiA and state, or cornplete
7.a. PLACEOF ENTRYINTO ACTIVEDUTY
addressif known)
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12. RECORD SERVICE Yea(s)
OF
SPECTALTY
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specialty. a. Date EnteredAD This Period fl AE ld
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periods of
b. SeparationDate This Period U AE t4
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This Period nn
c. Net Active Service nt l
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15. DAYS ACCRUED
Yes I No
15.b. H IG H SC H O O IG M OU AIE OR
ves I No
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15.a. MEMBERCONTRISUTED POST-VIETNAM
TO
x EQUIVALENT
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DENTAL SENVICES
ANO ALL APPROPRIATE
COMPI-ETEDEIITAL EXAMIT{ATIOT{
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18. REMARKS
GI BILL.
MEMFER CONTITIBUTED TO I{ONTGOT{ERT
*
TTIE INFOB.MATION CO}ITAINED T{EREIN TS SI-JBIECT t} COMPUTER HAreHlN*
DEI*ARTff-EI.IT oF DEFENSE OR S.ITI{ IfTHER AFFECTHD FET}TIRAL OR NON-FEDFRAL ACENCT
FOR, A,bID/OR COI'TTIIltIED
AHII T,() DHTERMINE El-t'fiIBILITY
F*R .ER{FICATIOI{ I.URF,OS,ES
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20 . M E M B E RR € QUE S T 5 COP Y 6BESEIUTTO
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21. STGNATURE MEMBEI* ElllQfranafto
OF
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(For use by authorized agencies only)
spEaAL ADD|TIOI{AI INFORMATTON
(lnclude upgrades)
24. CHARACTER SERVICE
OF
Ttor{
23. TYPEOF SEPARA
RELEASED FROM ACTIVE DUTY ttnrtnD i flt
CODE
27. REENTRY
26. SEPARATION OD E
C
AUTHORITY
25. SEPARATION
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COPY4
ouine rHts P€RtoD 30. MEMBERREQIJESTS
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Inttials
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N 0102-LF-006-5500 previous editions are obsolete
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