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DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Soctat Security ADMINISTRATION CERTIFICATION OF CONTENTS OF DOCUMENT(S) OR RECORD(S) BUREAU OF Ovo. AGE AND SURVIVORS Iwsurance | (This form must be executed by an authorized employee of the Social Security Administration) Social security account number Name of, vage earner r pelt. employe } , Fo The Cdinalh Y33~- S4Y- 3937 Every item in a block eh filled out with exact excerpts from the paper certified or the item must be marked “not shown.” If the date on which an entry was made in a family record is ‘‘not shown,”’ indicate under “Remarks” any allegation as to when the document or record was established. CROSS OUT ALL UNUSED SPACES. A. AGE (OR RELATIONSHIP) OF: 1. Name or Person as SHOWN ON EVIDENCE O Not SHOWN Oduruatclh i Person Havinc Custopy, ReLationsHip TO APPLICANT, AND ADDRESS: iru APPLICANT -d person Date RECORDED BirTHDAY AT WHICH AGE SHOWN C Last NEAREST ‘a NEXT Not GIVEN NAME OF Le sites mA NAME AND ve OF, a, i Cf certy, ping from a Bible, give date of publication) aT Custopian Documena/ No. 4 ——— a 2. NAME OF PERSON AS heck ON Et IDENCE BIRTHDAY AT WHicH AGE SHOWN Date RECORDED NEAREST CL] s C] Not Given C NAME OF FATHER C] : A NaME OF MOTHER CJ . AGE : Not SHown Not SHOWN Person Havinc Custopy, RELATIONSHIP TO APPLICANT, AND ADDRESS: {] NATURE OF EVIDENCE APPLICANT NAME AND Appress OF IssuInc AcENcy (If certifiing from a Bible, give date of publication ) EF] DocuMENT No. _ CUSTODIAN 3. NaME OF PERSON AS SHOWN ON EviDENCE Born AGE | BirTHDAY AT WHICH AGE SHOWN Date RECORDED Last NEAREST NEXT Not GIVEN NAME OF FATHER fe hee OF MOTHER AGE | Not SHowN LJ Not SHOWN Person Havinc Custopy, RELATIONSHIP TO APPLICANT, AND on NATURE OF EVIDENCE LJ APPLICANT NAME AND ADDRESS OF IssuinG AGENCY (Jf certifying from a Bible, give date of publication } Cl CusTopian Document No. é 4. NaME OF Person as SHOWN ON EVIDENCE BirtHDAY aT WHICH AGE SHowN Date RECORDED 2 ~ (_) Last NEAREST C] | NExT Not Given NaME OF MOTHER AGE NAME OF FATHER [J Not SHown ‘= Not SHOWN Person Havinc Custopy, RELATIONSHIP TO APPLICANT, AND ADDRESS: NaTuRE OF EVIDENCE - APPLICANT NAME AND ADDRESS OF IssuiNG AGENCY (If certifying from a Bible, give date of publication ) Document No. O CusToDIAN . MARRIAGE OF; BIRTHDAY | AT T WHICH AGE SHOWN (J Last NEAREST L] NExT - Not GIven NO. OF PREVIOUS MAR- RLAGES (1, 2, ETC.} NAME OF HUSBAND AS SHOWN ¢ ON Ev IDENCE ] Not SHown NO. OF PREVIOUS MAR- RIAGES (1, 2, ETC.) BirTHDAY AT WHICH AGE SHOWN LJ Last NEAREST C) NExT Name OF WIFE aS SHOWN ON EVIDENCE Not Given CJ Not SHOWN NATURE OF EVIDENCE PLACE OF MARRIAGE CJ MarRIAGE CERTIFICATE Person Havinc Cusropy, RELATIONSHIP TO APPLICANT, AND ADDRESS: DaTE OF MARRIAGE . C] APPLICANT NAME AND ApDREss OF Issuinc AGENCY (If certifying from a Bible, give date of publication ) | Custopian DocumENT No. Form OA-C704 6-62 Vv NW 55993° Pocld: 32945128 Page 21 (OVER)
a then Rab Res oa . ‘ DEPARTMENT OF HEA: . “WCATION, AND WELFARE TE SociaL SECURITY ADMINISTRA.. CERUFICATION BY. UNIFORMED SERVICES Bureau of Old-Age and Survivoygeavezeny, The information requested below is for“use in connection with a claim for social security benefits based at least in part on active service in the armed forces after September 7, 1939. : FROM: Social Security Administration Division of Claims Policy Entitlement Branch, Room 645 Baltimore, Md. 21235 Thomas C. Parrott LF .1. “a /ek/6in — Director ————___-""* PART I—TO BE COMPLETED BY SOCIAL SECURITY ADMINISTRATION LAST NAME - FIRST NAME - MIDOLE NAME DATE OF BIRTH DATE OF DEATH Oswald, Lee Harvey 10 /19/39 bal /2h /63 BRANCH OF SERVICE DATE(S) OF ENTRY INTO SERVICE | DATE(S) OF SEPARATION PLACE Marine Co ru SOCIAL SECURITY NUMBER OF SEPARATIO i "165 3230 Part II . . . Part III 2 below to be completed by the service department REMARKS: PART H1—SERVICE DEPT. CERTIFICATION ABOUT ACTIVE SERVICE AFTER SEPTEMBER 7, 1939. ‘ 1. DATE(S) OF ENTRY INTO 2. DATE(S) OF SEPARATION 3. CHARACTER OF SEPARATION(S) * (If Bad Condw?*  - ViCATE IF GIVEN ACTIVE SERVICE FROM ACTIVE SERVICE AS A RESULT OF A General couRT MARTIAL) 240ct56 : -11Sep59 Honorable *1F CHARACTER OF SEPARATION WAS NOT Honorable, Under Honorable Conditions, Dishonorable, Nor Bad Conduct as A RESULT or a General COURT MARTIAL, CHECK REASON FOR SEPARATION BELOW: a. lf period of service was less than 90 days, WAS INDIVIDUAL DIs- CHARGED OR RELEASED FROM ACTIVE SERVICE AS RESULT OF INJURY OR DISABILITY INCURRED OR AGGRAVATED IN SERVICE IN LINE OF DUTY? O yes ‘OD no @. [] DESERTION, b. (1 RESIGNATION FOR THE GOOD OF THE SERVICE (Officers Only). c. oO CONSCIENTIOUS OBJECTOR WHO REFUSED TO WEAR THE UNIFORM OR OTHERWISE TO COMPLY WITH LAWFUL ORDERS OF COMPETENT BS. IF A PERIOD OF SERVICE HAD AN ENTRY DATE AFTER 12/31/46 AND . MILITARY AUTHORITY. BEFORE 12/16/50, BY WHICH OF THE FOLLOWING WAS ENTRY EFFECTED? d. oO CONVICTION BY A CIVIL COURT FOR TREASON, SABOTAGE, ESPIO- NAGE, MURDER, RAPE, ARSON, BURGLARY, ROBGERY, KIDNAPPING, OD 'npuctep CALLED FROM ( ENLISTED ASSAULT WITH INTENT TO KILL, ASSAULT WITH A DANGEROUS INACTIVE SERVICE WEAPON, OR OF AN ATTEMPT TO COMMIT ANY OF THESE CRIMES. [] RE-ENLISTED [0D COMMISSIONED eQ NONE OF THE ABOVE. PART III-SERVICE DEPT. CERTIFICATION ABOUT RETIRED OR RETAINER PAY (See instructions on reverse side) IF THE VETERAN WAS NEVER RETIRED or TRANSFERRED TO THE FLEET RESERVE, check this box. .. . CJ Sign and return the form without answering items 1, 2 and 3 below. 1. (a) Was this veteran an enlisted member of the Army, Air Force, Navy, Marine Corps, or Coast Guard and retired after September 15, 1940, and before October 1, 1949, because ; of disability? 2... 2k ee ee ee ee ee et ee hee .- C] Yes C] No (b) Was this veteran ever retired or transferred to the Fleet Naval (or Marine. Corps) Re- serve after September 15, 1940, for any reason other than disability which is the proxi- mate result of the performance of active duty? 2... 1 ee ee ee ee ee ee [i Yes 7 No If answer to 1 (a) or 1 (b) is “Yes,” answer (c) and (d). ; (c) Was active service after September 15, 1940, and before July 25, 1947, used to establish eligibility to receive retirement or retainer pay? ....... ss ee O Yes Oo No (d) Was active service after July 24, 1947, and before January 1, 1957, used to > establish - eligibility to receive retirement or retainer pay? .. - ee LC] Yes _] No 2. (a) Has the retirement (or retainer) pay of this individual ever been fixed under a formula which includes a multiple of active service? . . 2... 2. wee ee ee te ee C] Yes O N If answer is “Yes,” answer (b) and (c). (b) Was this multiple increased because of active service occurring after September 15, 1940, and before July 25,1947? . 2... 6 1 eee ee eee we wee we ee ew . CJ Yes | No (c) Was this multiple increase because of active service occurring after J aly 24, 1947, and before January 1,1957? ... 1. 2. ee ee ee we ee eee we ry eo . C7 Yes Cc] N 8. Did the veteran have active duty or active duty for training after December 31, 1956? ... C] Yes C] No REMARKS BY CERTIFYING AGENCY: Served in an inective status in the Marine Corps Reserve from 12Sep59 to 13Sep60 when dischargbd as Undesirable. [] epntinuep on REVERSE SIDE orcanzarion ReCOrds service section SIGNATURE LU Hq. U: .S. Marine Coprs 273 an64 Head of Section DATE RANK OR TITLE Form eases Fae 55923 BDoocld: 32245128 Page 22