Combat Aircrew Wings

Please fill out as completely and accurately as possible and send to: William Rutledge Combat Aircrew Wings Coordinator 4419 Verley Ct. San Diego,CA 92117 Affidavit of Eligibility ________________________________________________________________ First Name, Middle, Last _____________________________________________________________________ Address, City, State _____________________________________________________________________ Telephone, FAX, Email SSN__________________ Rate (When in Vietnam)_______________ Dates in HA(L)-3__________________________Detachments________________ Det OinC_______________________Squadron CO___________________________ Names of others who can verify your flight status____________________ ____________________________________________________________________ Other Supporting Documents___________________________________________ Status: Active Duty___Retired___Honorably Discharged___ Other________ I hereby certify that the above information is true and correct to the best of my knowledge and recollection. I further certify that I flew combat missions while attached to Helicopter Attack (Light) Squadron Three and performed the duties of Combat Aircrewman. _______________________________________________________ Signature, Date