Michael L. Wilson Sr., Statement of Service, 1971 February 6
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DEPARTMENT OF THE AIR FORCE WASHINGTON, D. C. 20330
REPORT OF CASUALTY REPORT NUMBER AND TYPE R-397 Final DATE PREPARED 16 Feb 71
1. SERVICE IDENTIFICATION (Name, Service Number, Grade or Rate, Component, Branch and Organization) WILSON, Michael Lorenzo, 224-52-6824, MSgt, Regular, USAF 2. CASUALTY STATUS BATTLE X NON-BATTLE - DEATH Walter Reed General Hosp, Washington D.C. 24 Jan 71 Pulmonary artery right main thromboembolism, lumgs, edema, marked. Arteriosclerotic heart disease, marked, diabetes mellitus (Clinical) 3. DATE AND PLACE OF BIRTH, RACE RELIGIOUS PREFERENCE 9 Mar 97 - Fort McPherson GA - Caucasian 4. DATE AND PLACE OF LAST ENTRY ON ACTIVE DUTY IN CURRENT STATUS AND HOME OF RECORD AT TIME NOT APPLICABLE 5. SOCIAL SECURITY NUMBER,PAY GRADE,LENGTH OF SERVICE FOR PAY,BASIC PAY, INCENTIVE PAY 224-52-6824; E-7 CHECK IF APPLICABLE CREW NON-CREW 6. DUTY STATUS Retired effective 1 Sep 59 7. INTERESTED PERSONS (Name, Address,relationship) Mrs Carrie H Wilson 218 S Main St, Lexington VA 24450 wife 8. REPORT FOR VA TO FOLLOW YES X NO 9. REPORTING COMMAND AND DATE REPORT RECEIVED IN DEPARTMENT WALTER REED GEN HOSP WASH DC - 27 JAN 71 10 SELECTIVE SERVICE NUMBER, LOCAL BOARD, AND LOCATION (If unknown, enter date and place of first entry in Armed Services) NOT APPLICABLE 11. PRIOR SERVICE DATA X YES NO AF20363556; RA1293878 12. REMARKS; [blank] NOTE: THIS FORM MAY BE USED TO FACILITATE THE CASHING OF BONDS, THE PAYMENT OF COMMERCIAL INSURANCE, OR IN THE SETTLEMENT OF ANY OTHER CLAIM IN WHICH PROOF OF DEATH IS REQUIRED.
FOOTNOTES: 1 Adult next of kin. 2 Beneficiary for gratuity pay in event there is no surviving wife or child - as designated on record of emergency data. 3 Beneficiary for unpaid pay and allowances - as designated on record of emergency data.
13. DISTRIBUTION [blank] 14. BY ORDER OF THE SECRETARY OF THE AIR FORCE Roland J. Burns ROLAND J. BURNS, Lt col, USAF Directorate of Personnel Services
[seal] DEPARTMENT OF THE AIR FORCE HEADQUARTERS US AIR FORCE OFFICIAL
DD FORM 1 MAR [illegible] 1300 H6627