Fill and Sign the United Methodist Church Medical Report of Ministerial Candidate Revised August Part I Form

APPLICATION FOR GOLD STAR LAPEL BUTTON (Please read Privacy Act Statement, Instructions, and Information on back before completing. Use a different form for each applicant.) 1. I HEREBY MAKE APPLICATION FOR THE STYLE GOLD STAR LAPEL BUTTON INDICATED BELOW (X one) PIN JOINT AND SAFETY CATCH CLUTCH TYPE (Front View) (Back View) 2. DECEASED WAS A MEMBER OF (X applicable block and mail this application to the appropriate address.) a. ARMY (If Regular Army) (If Army Reserve) (1) MAIL TO: (2) MAIL TO: National Personnel Records Center, NARA (Military Personnel Records) 9700 Page Boulevard St. Louis, MO 63132-5199 Commander US Army Reserve Personnel Center Attention: DARPPAS-EAW 9700 Page Boulevard St. Louis, MO 63132-5200 b. NAVY (If application is made within one year from date of death) (1) MAIL TO: (If application is made after one year from date of death) (2) MAIL TO: National Personnel Records Center, NARA (Military Personnel Records) 9700 Page Boulevard St. Louis, MO 63132-5199 Chief of Naval Personnel (Pers-E) Washington, DC 20370-2000 c. MARINE CORPS (If application is made within one year from date of death) (1) MAIL TO: (If application is made after one year from date of death) (2) MAIL TO: National Personnel Records Center, NARA (Military Personnel Records) 9700 Page Boulevard St. Louis, MO 63132-5199 Commandant of the Marine Corps (Code MMDM) Washington, DC 20380-0001 d. AIR FORCE MAIL TO: e. COAST GUARD MAIL TO: National Personnel Records Center, NARA (Military Personnel Records) 9700 Page Boulevard St. Louis, MO 63132-5199 Commandant (G-PS) United States Coast Guard 2100 2nd Street, SW Washington, DC 20593-0001 3. APPLICANT'S RELATIONSHIP TO DECEASED SERVICEMEMBER (X one) WIDOW STEPFATHER SON DAUGHTER BY ADOPTION WIDOWER MOTHER THROUGH ADOPTION DAUGHTER BROTHER MOTHER FATHER THROUGH ADOPTION STEPSON SISTER FATHER FOSTER MOTHER IN LOCO PARENTIS STEPDAUGHTER HALF BROTHER STEPMOTHER FOSTER FATHER IN LOCO PARENTIS SON BY ADOPTION HALF SISTER 4. SERVICEMEMBER DATA a. NAME (Last, First, Middle Initial) d. DATE OF DEATH (YYYYMMDD) b. PAY GRADE OR RANK e. BRANCH OF SERVICE c. SOCIAL SECURITY NUMBER OR SERVICE SERIAL NUMBER f. GEOGRAPHICAL AREA OF SERVICE 5. SEND GOLD STAR TO: (Type or print name and address as this information is needed for record and shipping purposes) a. NAME (Last, First, Middle Initial) b. NUMBER, STREET, AND APARTMENT NUMBER (If applicable) c. CITY, STATE, AND ZIP CODE 6. SIGNATURE OF APPLICANT DD FORM 3, FEB 2000 PREVIOUS EDITION IS OBSOLETE. Reset PRIVACY ACT STATEMENT AUTHORITY: 10 U.S.C. 1126 PRINCIPAL PURPOSE(S): To evaluate the applicant's eligibility to receive the Gold Star Lapel Button. ROUTINE USE(S): To identify the applicant and establish a personnel record. DISCLOSURE: Voluntary; however, if not provided, an eligible individual may not be issued the Gold Star Lapel Button. INSTRUCTIONS Application must be typewritten or completed legibly in ink, signed by applicant and forwarded to the appropriate address listed in Item 2. INFORMATION Public Law 534 - 89th Congress, directs the design and distribution of a lapel button, to the known as the "Gold Star Lapel Button," to identify widows, parents and next of kin of members of the Armed Forces of the United States who lost their lives: (1) During World War I, April 6, 1917 to March 3, 1921; (2) During World War II, September 8, 1939 to July 25, 1947; (3) During any subsequent period of armed hostilities in which the United States was engaged before July 1, 1958 (United Nations action in Korea, June 27, 1950 to July 27, 1954); (4) After June 30, 1958 (a) while engaged in an action against an enemy of the United States; (b) while engaged in military operations involving conflict with an opposing foreign force; (c) while serving with friendly foreign forces engaged in an armed conflict in which the United States is not a belligerent party against an opposing armed force.* The law provides that one Gold Star Lapel Button will be furnished, without cost, to the widow and to each of the parents and the next of kin. The term "widow" includes widower; the term "parents" includes mother, father, stepmother, stepfather, mother through adoption, father through adoption, and foster parents who stood in loco parentis; the term "next of kin" includes only children, brothers, sisters, half brothers, and half sisters; and the term "children" includes stepchildren and children through adoption. The law further provides that not more than one Gold Star Lapel Button may be furnished to any one individual except that, when a Gold Star Lapel Button furnished under this section has been lost, destroyed, or rendered unfit for use without fault or neglect on the part of the person to whom it was furnished, the button may be replaced upon application and payment of an amount sufficient to cover the cost of manufacture and distribution. * Operations subsequent to June 30, 1958 which are recognized by the Department of Defense in establishing eligibility for the Gold Star Lapel Button include: - Lebanon, July 1, 1958 to November 1, 1958 Republic of Vietnam, July 1, 1958 to March 28, 1973 Quemoy and Matsu Islands, August 23, 1958 to June 1, 1963 Taiwan Straits, August 23, 1958 to January 1, 1959 U.S. operations in direct support of the United Nations in the Congo, July 14, 1960 to September 1, 1962 U.S. operations of assistance to the Republic of Laos, April 19, 1961 to October 7, 1962 Berlin, August 14, 1961 to June 1, 1963 Cuba, October 24, 1962 to June 1, 1963 Congo, November 23, 1964 to November 27, 1964 Dominican Republic, April 28, 1965 to September 21, 1966 Korea, October 1, 1966 to June 30, 1974 Cambodia, March 29, 1973 to August 15, 1973 Thailand, March 29, 1973 to August 15, 1973 Cambodia, April 11, 1975 to April 13, 1975 Vietnam, April 29, 1975 to April 30, 1975 Mayaguez Operation, May 15, 1975 Lebanon, June 1983 to Grenadan Operation, October 23, 1983 to November 21, 1983 Operation Eldorado Canyon, April 2, 1986 to April 17, 1986 Panama, December 20, 1989 to January 31, 1990 Desert Shield/Desert Storm, August 2, 1990 to November 30, 1995 Haiti, September 16, 1994 to March 31, 1995 Somalia, December 5, 1992 to March 31, 1995 Operations in the Persian Gulf, November 30, 1995 to (to be determined) Operations in and around the Former Republic of Yugoslavia, December 20, 1996 to June 20, 1998 and any subsequent operations as may be announced by the Secretary of Defense. DD FORM 3 (BACK), FEB 2000