Form Ansc 7035 - Change Of Membership Status Form - Us Coast Guard Auxiliary
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DEPARTMENT OF
U. S. COAST GUARD AUXILIARY
HOMELAND SECURITY
CHANGE OF MEMBERSHIP STATUS
U.S. COAST GUARD
ANSC 7035 (07-10)
SECTION I - To be completed by Flotilla Commander
FIRST NAME AND MIDDLE INITIAL
MEMBER NUMBER
LAST NAME
To:
| | | | | |
As provided in the Auxiliary Manual, COMDTINST 16790.1 (Series), you will be recommended for
disenrollment from the Auxiliary for non-payment of Financial Obligations for or since the year
______ amounting to $ ______________, unless the full amount is received by your Flotilla
Commander within thirty (30) days from the date of this notice. You will not be eligible to remain a
member of this flotilla, transfer to another flotilla or seek Retired Member status, until your financial
obligations are met.
Flotilla Commander
Date of Notice
SECTION II - To be completed by Member
To:
FLOTILLA
Date: ___________
An amount to pay my Financial Obligation is enclosed. I want to remain in Flotilla __________.
I desire Retired Member status. My date of enrollment is _______________.
I desire to transfer to Flotilla _______ in this district.
(Complete MEMBER TRANSFER REQUEST,
ANSC 7056 , and attach to this form.)
I desire to disenroll. * My reason is: ______________________________________________
________________________________________________________________________
* My membership card is enclosed.
Member signature ______________________________
SECTION III - To be completed by Flotilla Commander
To:
DSO-HR _____________
Recommend disenrollment effective ____________________
for Non-payment of Financial Obligations.
at Member’s Request.
Member desires and is eligible for Retired Member status:
Yes
No
Death of member.
Name and address of next of kin:
Flotilla Commander (Required)
Date
Division Captain (Optional )
Date
SECTION IV - To be completed by DSO-HR
To:
DIRECTOR OF AUXILIARY
Recommend Disenrollment.
Member requests transfer to Flotilla _______________________.
Member desires and is eligible for Retired Status.
DSO-HR
Date
SECTION V - To be completed by Director of Auxiliary
To:
DCP, DIVISION ________ and FLOTILLA COMMANDER, Fl. ___________
Member was disenrolled. Effective date _________________
Adm.
Failed to pay Financial Obligations
Death of Member
Member request
Member was transferred to Flotilla _________________. Effective date ______________
Member was transferred to Retired Member status. Effective date________
Recommendation disapproved; see attached comments.
Director of Auxiliary
Date
Previous editions are obsolete
CGAUX-36
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