WHY WE ARE SENDING YOU THIS FORM: is either

14
WHY WE ARE SENDING YOU THIS FORM:
We cannot respond to your request at-this time. The reasp1
is either that:
* We are unable to locate a record with the r.formaticl, pr:vida ir y: cr
nal ir.cuirj
-or* The record needed to answer your inquiry was lost in the July 1973 fire that destroyed millions of records here
at the National Personnel Records Center. The records stored in the area which suffered the most damage in the
fire were those of;
*` .Ary veterans discharged ordeceasod between November 1, 1912, and December 31, 1959
* Air Force veterans discharged deceased. or retired before January 1. 1964, whose names come
alphabetically after Hubbard James E..
The information that you provide on the back of this form may help to locate the record if it is available; or ifmay enable
the Center to make use of various alternate sources to reconstruct some of the basc service record data if the record is
not available. Please note that if the only document that you need is the report of separation OD Form 214, WDAGO Form
53-55, etc., this may be available from a former employer or the recorder's office of the city or county where the veteran
lived just after separation/discharge.
2. WHAT YOU NEED TO DO:
the other side cf this form NA 13075 as completely as possible, along with any other forms that you
may have received with this one, such as Standard Form SF180 and NA Form 13055;
fl Fill out
Attach copies of any papers yçu have that relate to the requested milita' service, such as military orders,
award citations, and military addresses as shown on letters mailed home; and
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Send the above items and the original s/gned request that we are returning to you now to the National
Personnel Records Center at the address shown below. Do not send in this form by its&f.
3. NOTE: Are you request3ng military service medals only? If so, do you have a copy of the report of
separation CD Form 214, WDAGO Form 53-55, etc. and other military papers that show which medals were earn'ed? If
you send such information about medals you do not need to fill out this NA Form 13075. However, you still must also
return a completed SF 180 or your criginal request. Finally, if possible please send a list of the names and locations of all
military units or ourfits to which the veteran was assigned, including the dates, while on active duty. This may help
determine eligibility for unit awards.
.
J..:j H PRACY ACT OF 1974 CoMrUANCE:FORMAflON
The following information is provided in adthrdancóèith5 IJ.s.C:552a1e13 and appliesjo this loan. Authority for collection of the infonnatiorf is 44
usc 2907 301, and 3103 and EQ 97 of November 22 1943 Disclostn of the inforinaton is volurrtary If the requered inforinaton nct provicer may-delay servicing yous-2nquuy-bacause the National Personnel Records Cs.itr ma' not have all of the urformaton needed to locate the rccords}
sought The purpose of tnt Lnfotnzvoi on V-us form o to assist the Natjnal Pereornel Records Ceiter in locating the coriect military service recordisi
or iifonnationto answer your.inquiry. This form iiiheñflled in the requested rrulltary service rerd as a record of disclosure. The form may be disclosed
to Deparvneth of Defense component cr.the Dor,ànment of TransportaTion Coast Guardl, if the Nicr.ai Persor.nei Records Center tansfers afl or os
of tnose records to avon agency. if the service mernef was a member of the NstionalGuard,xhe form nay be disci:-;
LT Gerer c
appropriate State. Disthct of Columbia. or Puerto Rico,where ho or she served. The farm-may also be disclosed wnen the military service merrber or.
In the case of a deceased service memba' the mflrtarysar.ico department. a4thcnzeS a zpec4lc individual or organ.Izaucr to have acceos to the military
$vr4cs record.
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PAPERWORK REDUCTION ACT PBLI BURDEN STAT2.tENT
You are rot required to provide the infonnation reqbèsted pn torni mat s subject to tie Paperwork Seduction Act cries: ths farm displays a valid OMS
control number. Thu information requested on this.form is bein9 collected and used byte National Personnel Records center to icentify and locate rniiltar
service records that could not be identified and located in cespenso to-thu odginal inquiry..JFablic. burden reporting for this collection of irtfoanation is
estimated w be five minutes per response. inciuding time for reviewing iristruttionsand completing and reviewing the collection of information. .:Scnd
cornrnemsrsgarding the busdenes-timatcr any other aspect of the collection of ioforma-rjon,-irtcluding suggestions for reducing this burden, to National
Arcbivetind Reccms Adrrãrdsa-ation NHP, aGol Adeiphi Road, Colleije Park. MD 2O74-O-0O1. DO NOT SEND COMPLETED FCRMS TO THIS ADDRESS.
SEND COMPLETED FORMS To THE .ADDRESSSHOWN 98.0W.
Date;
For tno Chief.
Army Reference Branc,
Air Force Reference Branch
Navy Reference Eran:h
Records Reconstruction Branch
Military Operations Branch
o
o
o
o
o
NATIONAL PERSONNEL RECORDS CENTER
Military Personnel Fecordel
9700 Page Avenue
St. Lous. MO 63132-BlOC
NATIONAL ARCHIVES AND RECORDS ADM!NI5TAATION
NA FO.9M 13075 REV. 12-99
LOCATION OF MILITARY RECORDS
`he various categodee of rnilitaiy Service records are described in the chart below. For each category there is a code ntrnbcr Which indicates the address
the bottom of the page to which this request should be sent.
* l-ca!th and personnel records. In most cases involving individuals no longer on active duty, the personnel record, the health recard, or both can be
*btained front the same location, as shown or. the chart However, some health records are available from the Department of Veterans Affairs VA
tecords Management Center Code TI. A resuest for a copy of the health record should be scat to Code 11 if the pcrson was discharged, [cUred. or
eleased froni active duty separated on or after the following dates ARMY-October 16, 1992; NAVY-Januasy 31, 1994; AIR FORCE and MARTht
:ORPS-May 1, 1994; COAST GUARD-April 1, 1998. Health records of persons on active duty arc genertilky kept at the local scnicung clinic, and
isuaUy are available from Code II a week or two after the last lay of active duty.
Recnrds at the National Personnel Records Center, Note that it tijçcs at least three months, and often six or seven, for the ide to reach the Natiena!
iersonnel Records Center Code 14 in St Louis after the military obligatien has ended such as by discharge. Ir' only a short Line has passed, please
cid the inqtüry to the address shown for active or ow-rent reserve members. Also. if the person has only been released from active dut but is still in a
cserve status, the personnel record "ill stay at the location specified for reservists. A person can retain a reserve obligation for several years. even
-ithout attending ueetings or receiving annual waining.
Definitions and 2bhrvTntions. DSCRARGED-thO individual has no currentmilitarv stars; F.kTJrH-Records of physical excn'±iations. dental
.
reatmenç and outpatient medical treatrncnt received while in; duty status does act include records oltreatnient whi'.e hcspiuilized'r; TORL-Teniporan
Jisabiliri Retired List.
4. Service tompjeted before World War!, The oldest records pertaining to military service veteralij are at the Nattonal Archves. for service that was
it / C'Jr ``
inot .cr.., - In'" `a `:_`
tV<Ii in
`_`3'IECCO,,ps
edbcjatoq `zdate,.
request
these
I/I/I 9C5: COAST GU?32-l/I/1S98. National Archives Trust Fund INATF1 fogas must be used to
records. Obtain the fonas by e-rnthl
born nqurr.tnara.gov or write to the Code 6 addrers.
H
CURREYr STATUS OF SERVICE MZM]3ER
WHERE TO WPJTE .&DDRESS CODE
Oischaraed. deceased, or retired with mv See ;aj-aaoh I. cbo'c. if re'au:sdne heatth record 1
I 4 I
Active irchxfirc National Guard on active duty in the Air Force1. `!`ORL. or ceneral officers retrred v,ith ca':
Reserve, retired reserve in nonpav status, cus-rent Na:onal Guard officers net on active durc in the Air Force. cc Natienal
2
Guard released frcrri active dun' in the Air Force
Currrs: Nsticna Guard enlisted not on active duty ii'. the Air Force
I 3
Discharged. deceased, orretired See parataDh I, uove. tt'rec,ucstinz health recordJ
14 I
Aa:ivejcscrce,or
14
Discharged. deceased, or retired iee paraca-aoh I. above. tt reauesttn health rccord
individual Ready Reserve or Fleet Marine Cocos Reserve
4
Active. Selected Marine Corts Rescn-e, cc TDRL
I
Oischarzed. decmased., or retired Sc: oaracach I aiote, if rcnueatjc health reccrd.1
I 14
Reserve; or active duty records oCcurrent National Guare mcmtcrs `ho performed
I
service in the U.5. Army bet'orc "i!1fl2
/
Acuve enlisted irtcludin National Guard en active duty in the L'S. Army or TORE enlisted
9 I
Ac:;ve othccrs iricludina National Guard on actrve duty Lii the U.S. Array or TORI, oticrrs
I
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Current National Guard enlisted act on rotive
iz..'_-,,v';Jtc reu.;rds cr'Armv active dur; certhnt-rted aer di'3C;TtI 13
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Giscoarged. deceased, or rented tice paraac I. ai-e. U recoc pa haw;;oo;r'i.,
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Fist, see instructions on reverse, to be sum that yOU send in the appropriate forms and any other papers.
Branch of service 0 Army 0 Air Forte
[ç Navy 0 Marine Corps 0 Coast Guard
Data of birth 1City and state countryl of birth
Was service six
months active duty
for training only?
Eves
One
Mames used during service and nicknames, if any
last
Served as
o
-
middle
first
Home addresl
include serial/service numbers
when entered service
officer
-
--
city_
county
State
city
county
state
;-
0 enlisted
;t enlisted:
Finalrank
0 volunteered
or
Q drafted
Veteran's social security number
when released from
active duty --
Selective
local board number
Service
-
state
city
veteran's Selective Service number
Names of dose relatives when military service began parents, siblings, spouse, children
Month/day/year
began active duty
Place of enlistment or induction where veteran took oath of service, such as examining station, reception
center, or place of basic training Show name of military facility, city state.
Place of basic training and month/day/year began if different from place and date shown online above
Type oi niiitarj assignment infantry, aircorne. engineer, bomoers. tignters. supply, maintenance, food service. etc.
Last military organization Please show ftili unit designations, such as army, division. regiment, bartalion. comoany, and include location.
Separation station if this service member was released at a separation station after leaving the last
Month/day/year released
from active duty
`permanenC organization or unit' Please include location of separation Station.
If this veteran is deceased,
5:-ow date of death
Mcnth/dayfyear of any reenlistments, inckiding full designation and lccoticn cf unit to
which assigned at the tme
Did the veteran ever
o
Don't know
If yes, show claim number:
Don't know
If yes, show month/year: from
and branch of service:
o
Don't know
if yes, show state:
U Yes
o
Don't know
If yes, show state:
and when month/day/year
e. Retire from any militarysservice branch? UNo
U Yes
U Don't know
If yes, show branch:
f. Spend time on the Temporary
Disabiii,Rë'tired Ust'TDRL?
ONo
0 Yes
0 Don't know
If yes, show branch:
month/day/year
g. Serve active duty in any other military
service branch in later years?
ONo
h. Work for the Federal government as
a c;viiian?
UNo
a. File a claim for VA benefits?
ONo
0 Yes
b. Serve in the Reserves after release
ONo
0 Yes
c. Receive a state bonus for military
service?
ONo
U Yes
d. Serve in the National Guard?
ONo
from active duty period shown above?
U Yes 0 Don't know
0 Yes
o
Don't know
If yes, show branch:
Imonth/day/yearl
to
month/year paid:
DAnny DAir
to
mo/yr retired:
and when:
-
to
-
-
and when:
to
if yes, show agency name:
c:rj:state: --_______ when Imo/yrl:
to
Purpose:
Optional-An explanation of the purpose of the request is strictly voluntary. Such information may help the National
Personnel Records Center to provide the best possible response and will in no way be used to make a decision to deny the request.
Daytime phone
number
Today's date
-
Please remember to return
your original inquiry.
co Before you send this form, please make sure that you have followed the instructions in the What You
Need To Do" section on the other side. Otherwise, It may not be possible to service this request.
NATICNAL ARCHIVES AND RECORDS ADMINISTRATION
NA FORM 13075 Sack REV. 1 2-99
.
CFR1228.-I62a
REQUEST PERTAINING
TO MILFFARY RECORDS
-
_____________________________
rwO. 3u'Z'UOLY
txtrtlf31flOo
the
insm1ctions
at
bottom
the
review
beforeiii
thoroughly
please
To ensure the best possible service,
power.
out this form. Please print clearly or tYpe. Ifyou reed more space. use plain
Prtvo'fl SiionunusabIe
-`-
OMti
.--
SECTION! INFORMATION NEEDED TO LOCATE RECORDS Furnish as much as possible.
-
2. SOCIALSECURITY No. a. DATE OFBIRTH
I: tt{AMELISEDDUTRLNGSERVICELast,tirst,cniddle
L PLACE OF BIRTH
For an effective records search, it is important that ALL service be shown below.
S. SERVICE. PAST AND PRESENT
SERVICE NUMBER
DURING THIS PERIOD
CHECK ONE
DATES OF SERViCE
-
DATE ENTERED
BRANCH OF SERVICE
DATE RELEASED
OFFICER
if unknown, please w,jte unknown.'
ENLISTED
a. ACTWE
*
SERVICE
.
b. RESERVE
SERVICE
C.
.
-
NATIONAL
GUARD
,.
IS TS PERSON DECEASED? Ii "YES" enter `he date ofdeaih.
LJyp5
LJNO
7. 15 VAS ThiS PERSON RETffiED flONt MILIT.Y SERVICE?
LIVES
I
SECTION lI-INFORMATION AND/OR DOCUMENTS REOUESTED
I. REPORT OFSEPARATION DD Form 214 orequivalent This contains information normally needed to vc-if,- rruiitarv serice. A copy may
he sent to the veteran, the deceased veteran's ner<tof kin, or other persons or organizations if authorized in Section III, below. NOTE: If more than one
period of service was performed, even in the same branch, there may be more than one Report of Separation. Re sure to show EACH year that a epon
at' Separation was issued, for which you need a copy.
0 An UNDELETED Report of Separation is requested for the years
This normally will be a copy of the Ml separation dacument including such sensitive items as the character of separation. authority for searation, reasor.
for separation, reenlisttnent eligibility code, separation SPD/SFN code, and dates of time lost. An undeleted version is ordinarily required to deterinli-te
eligibility for benefits.
0 A DELETED Report of Separation is requested for
the years
`ftc following information will be de!eted from the copy sean: authorit'. for separation, reason for separation. reenlistment elibilir: code, separation
ISPD/SPN' code, and for separations after June 30, 1979, character of separation and dates of time lost.
2. OTHER INFORMATION AND/OR DOCUMENTS REQUESTED
3 PURPOSE OPTIONAL--An explanation of the purpose of the request is su-ictlv voluntar, Such information may help the agency ar.swering
this request to provide the b9z possible response and will ira no way be used to make a decision to dcv the requect
SECTION III RETURN ADDRESS AND SIGNATURE
-
I. REQUESTERtS
E
Military service member or veteran identified in Section L above
Leoal guardian must submit copy of court appointment
0
Next of k:n ot'deceased veteran
Other speciñ
rulation
2. SEND INFORaATION/DOCUMENTSTO
3. AUTHORIZATION SIGNATURE REQUWED Sec instruction 2. below.
I declare or certify, verify, or state under peaaltv of pezun' under the laws of the
United States of America that the information in this Seetton 0 is an: and correct.
t?!ezse pnc or type. 5cc instruction 3, below.
Signature at requester Please do not pnnt.
Apt.
Cit'
State
`,t:s tcrr,i is av.'.ilahic at hr:r.
-
`v `4-
ZIP Code
?lJr::. `ot' `r!tpoPia! `ni'jrt/7
Date
at
this request
Daiiir,e pnonc
E-mail address
on t N'cticna! Archi',c'; andR:',
a .&Jrnins:rctic:a `NAi `IV eb site