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RECORD OF DISCHARGE FROM THE U.S. NAVY RESERVE (INACTIVE)
ACTIVITY TITLE
HOME ADDRESS AT TIME OF DISCHARGE
TYPE OF DISCHARGE AND AUTHORITY
HONORABLE
MILPERSMAN 1910-104
CERTIFICATE ISSUED
REMARKS
Recommended for Reenlistment
DISCHARGE DATE
IMMEDIATELY REENLISTED
NAME (First, Middle, Last)
RATE
SOCIAL SECURITY NUMBER
BRANCH AND CLASS
NAVPERS 1070/615 RECORD OF DISCHARGE FROM THE U.S. NAVY RESERVE (REV 08-06)
S/N: 0106-LF-133-2300
Page 2 of 3
PART 2 – SERVICE RECORD COPY
FOR OFFICIAL USE ONLY - PRIVACY SENSITIVE
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