VETERAN INFORMATION FORM

NAME: ____________________________________________________________________________

PRESENT ADDRESS: ________________________________________________________________

CITY: ______________________________   STATE: __________   ZIP: _______________________

BIRTHDATE   MO: ________ YR: ________   DEATH DATE   MO: ________ YR: ________

PLACE OF INTERNMENT (if deceased): _________________________________________________

BIRTHPLACE – CITY: _____________________________ ________ STATE: __________________

BRANCH OF SERVICE: ____________________________ SERVICE NO.: ____________________

ENLISTMENT DATE: ______________________________ DISCHARGE DATE: _______________

CONFLICT INVOLVED WITH (circle) WWII, Korea, Vietnam, Desert Storm

Other U.S. Service (please designate)______________________________________________________

RESIDENCE AT ENLISTMENT: _______________________________________________________

Date you became a resident of Sterling Township: ___________________________________________

A biography of the registrant’s military service such as bases where stationed, countries visited, battles involved with, or any other information about experiences pertaining to his or her time in the service would also be helpful.  Please attach to this form, or use other side.

This form is being submitted by:

NAME: _____________________________________________________________________________

ADDRESS: _________________________________________________________________________

CITY: __________________________ STATE: ______ ZIP: ________ PHONE: _________________

DATE: _____________________

Please return the completed form to: Historians of Sterling Township, Box 48, Sterling, PA 18463 or email to historiansofsterlingtownship@gmail.com