NAME: ____________________________________________________________________________


PRESENT ADDRESS: ________________________________________________________________


CITY: ______________________________   STATE: __________   ZIP: _______________________


BIRTHDATE   MO: ________ YR: ________   DEATH DATE   MO: ________ YR: ________


PLACE OF INTERNMENT (if deceased): _________________________________________________


BIRTHPLACE – CITY: _____________________________ ________ STATE: __________________


BRANCH OF SERVICE: ____________________________ SERVICE NO.: ____________________


ENLISTMENT DATE: ______________________________ DISCHARGE DATE: _______________


CONFLICT INVOLVED WITH (circle) WWII, Korea, Vietnam, Desert Storm


Other U.S. Service (please designate)______________________________________________________


RESIDENCE AT ENLISTMENT: _______________________________________________________


Date you became a resident of Sterling Township: ___________________________________________


A biography of the registrant’s military service such as bases where stationed, countries visited, battles involved with, or any other information about experiences pertaining to his or her time in the service would also be helpful.  Please attach to this form, or use other side.


This form is being submitted by:


NAME: _____________________________________________________________________________


ADDRESS: _________________________________________________________________________


CITY: __________________________ STATE: ______ ZIP: ________ PHONE: _________________


DATE: _____________________

Please return the completed form to: Historians of Sterling Township, Box 48, Sterling, PA 18463 or email to