MILITARY REGISTRY

						WAR:______________________



					OTHER SERVICE:____________________



NAME OF PARTICIPANT: _____________________________________________________





               COUNTY FROM WHICH SERVED (Check One):

/_/ Allegan   /_/ Berrien   /_/ Cass   /_/ Kalamazoo   /_/ Van Buren

                    /_/ Other ______________________





COUNTRY FOR WHICH SERVICE WAS PERFORMED: _________________________________





BRANCH OF SERVICE: ______________________ LENGTH OF SERVICE:______________





DESCRIPTION OF SERVICE: __________________________________________________



__________________________________________________________________________



__________________________________________________________________________



__________________________________________________________________________



__________________________________________________________________________





EVIDENCE OF SERVICE: _____________________________________________________



__________________________________________________________________________



______________________________________________________ (Attach copies)





Pension: (check one)  Yes /_/    No /_/   Rejected /_/   Unknown /_/

PERSONAL HISTORY

Birthdate & Place ________________________________________________________

		 (Date)     (City)     (County)      (State/Country) 



Deathdate & Place ________________________________________________________

		 (Date)     (City)     (County)      (State/Country) 



Burial: __________________________________________________________________

		(Cemetery)    (City)     (County)   (State/Country)  





Does grave have a marker?   Yes /_/   No /_/





Parents: _________________________________________________________________





Siblings: ________________________________________________________________



__________________________________________________________________________



__________________________________________________________________________





Spouse: __________________________________________________________________





Date & Place of Marriage:  _______________________________________________

			  (Date)    (City)(County)  (State/Country)



Other Spouses: ___________________________________________________________



__________________________________________________________________________





Children: (please list name, birthdate, spouse)



1. _______________________________________________________________________



2. _______________________________________________________________________



3. _______________________________________________________________________



4. _______________________________________________________________________



5. _______________________________________________________________________



6. _______________________________________________________________________



7. _______________________________________________________________________

(Please attach separate sheet for additional children)





All residences of participants: __________________________________________



__________________________________________________________________________



__________________________________________________________________________





SUBMITTED BY:



Name: ____________________________________________________________________



Address: _________________________________________________________________

	(Street)  (City)  (State)    (Zip Code)



Relationship to Participate: _____________________________________________



Date of Submission: ______________________________________________________



Military Registry is a project of the Van Buren Regional Genealogical

Society, P.O. Box 143, Decatur, MI 49045

__________________________________________________________________________

VBRGS Use Only:



Date Received: __________________________________ Category/#: ____________



Approved by: _____________________________________________________________



Notes: ___________________________________________________________________