|
TOWN OF BROOKHAVEN
Full Name
______________________________________________________________________ Date and Place of Birth _____________________________________________________________ Address at time of entrance into service________________________________________________ Name of Father ___________________________________________________________________ Maiden Name of Mother ____________________________________________________________ Employed by before entering service __________________________________________________ Trade or Occupation _______________________________________________________________ Names of Schools Attended: _______ Years at ________________________________________ Primary School _______ Years at ________________________________________ High School _______ Years at ________________________________________ College _______ Years at ________________________________________ Other Date and place of Separation ______________________________________________________________ Military or Naval training, occupation, qualifications, etc. _______________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ Regiment, Company, Battalion Group, Squadron, etc. __________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ Promotions ____________________________________________________________________________ Left Cont’l U.S. (Date) ________ From ________ on (boat)___________ Arrived at (place) ___________ Other sailings, Give Dates, ships, places _____________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ Final Arrival U.S. (Date)_______ from (place)_______ on (ship) __________ At (place) ______________ Army or M.C. Service: Engagements, Campaigns, Theatres of Operation, etc. Navy of C.G Service: Stations, Vessels served on, Enemy Encounters, etc. ____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Decorations, Citations, Ribbons, etc. _______________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Other information______________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Photograph of Veteran included ____________ Will be returned
|