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NAME (Last, First, Middle) SOCIAL SECURITY NUMBER. HOME OF RECORD (Street, City, State, ZIP Code) PLACE OF ENLISTMENT/REENLISTMENT (Mil. Installation, City, State) DATE OF ENLISTMENT/ REENLISTMENT (YYYYMMDD) DATE OF BIRTH (YYYYMMDD) PREV MIL SVC UPON ENL/REENLIST.
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