TOWN OF BROOKHAVEN
War Service Record of Veterans of the Korean War
Please mail completed forms to
Mr. Victor Massian
Longwood JHS
198 Longwood Road
Middle Island, NY
11953
Full Name
______________________________________________________________________
Please print
Last
First Middle
Date
and Place of Birth
_____________________________________________________________
Address at time of entrance into
service________________________________________________
Name of Father
___________________________________________________________________
Maiden Name of Mother
____________________________________________________________
Employed by before entering service
__________________________________________________
Trade or Occupation
_______________________________________________________________
Names of Schools Attended:
_______ Years at
________________________________________ Primary School
_______ Years at
________________________________________ High School
_______ Years at
________________________________________ College
_______ Years at
________________________________________ Other
Date and place of induction
___________________________________________Branch_____________
Date and place of Separation
______________________________________________________________
Military or Naval training, occupation,
qualifications, etc. _______________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Regiment, Company, Battalion Group, Squadron,
etc. __________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Promotions
____________________________________________________________________________
Left Cont’l U.S. (Date) ________ From
________ on (boat)___________ Arrived at (place) ___________
Other sailings, Give Dates, ships, places
_____________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Final Arrival U.S. (Date)_______ from
(place)_______ on (ship) __________ At (place) ______________
Army or M.C. Service: Engagements, Campaigns,
Theatres of Operation, etc.
Navy of C.G Service: Stations, Vessels served
on, Enemy Encounters, etc.
____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Decorations, Citations, Ribbons, etc.
_______________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Other
information______________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Photograph of Veteran included ____________
Will be
returned