Please make sure all boxes have text inside. Use 'None' or 'N/A' if you have no data for any specific box. Please enter your name: Please enter your email address: May we contact you? Yes No NAME OF VETERAN PARENTS' NAMES INCLUDING MOTHER'S MAIDEN NAME WIFE'S MAIDEN NAME & CHILDREN'S NAMES DATE OF BIRTH DATE OF DEATH (IF DECEASED) DATE OF ENTRY TO SERVICE DRAFTED? Yes No DATE OF DISCHARGE HIGHEST RANK BRANCH OF SERVICE Army Navy Marines Coast Guard Merchant Marine WAC AAF UNIT(S) MEDALS, AWARDS, CITATIONS RECEIVED THEATER(S) OF SERVICE RESIDENCE AT TIME OF ENTRY INTO SERVICE (Township or City, State only) PRESENT RESIDENCE (If Living or Place of burial if deceased): PICTURE ATTACHED: RETURN? Yes No File to upload: File to upload: Please enter any further information you may want us to know:

Please supply as much of the above information as is known.

Any additional information will be kept in a family file at Ripley County Historical Society

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