Application to STATE OF IOWA for World War II Service Compensation
FORM NO. 1. Application for payment from funds of World War II Service Compensations Board of the State of Iowa. Form No. 1 is for LIVING VETERANS only. Beneficaries of deceased vererans will write to Executive Secretary. World War II. Service Compensation Board Des Moines, Iowa for Form 2 stating relationship to deceased.
Study this form carefully before filling it out.
Read and follow the instructions.
Errors and omissions will delay payments.
PRINT IN INK OR USE A TYPEWRITER.
DO NOT USE PENCIL.
The applicant named below hereby applies to the World War II Service Compensation Board, State of Iowa for compensation as provided for by Chapter 55[?] Acts of the 52nd[?] Generaly Assembly, State of Iowa
1. Name Of Applicant
First Name Middle Name or Initial Last Name
Clarence Oliver Williams
2. Show Address to which check or mail should be sent.
House No and Street or R.F.D. Route No and Box No 1303 Avenue "B"
City or Town County State : Do Not Abreviate
Council Bluffs, Pott. Iowa
3. Legal Residence of applicant for the Period of Six (6) Months immediately
prior to actual induction or enlistment in the armed forces of the United States
House No and Street Or State
R.F.D. Route No and Box No City or Town Do Not Abreviate
1303 Avenue "B" Council Bluffs, Iowa.
4. Date of Applicants Birth Place of Applicants Birth
Month Day Year Town State
December 17th 1911 Crescent Iowa
5. Applicants Service or Serial Number 33738878
6. Name Under Which Applicant Served in the armed forces of the United
States
First Name Middle Name or Initial Last name
Clarence Oliver Willams
7. Show Date of Entry into active Show Date of Separation from
service active service
Month Day Year Month Day Year
March 30 1944 May 3 1946
8. This item is for Enlisted Personal only show number of months and days of Terminal leave for which applicant received pay under the Armed Forces Leave Act of 1966 Month 1 Days 21
9. If applicant claims credit for foreign service
Date of Departure from Date of Return to
United States United States
Month Day Year Month Day Year
1. January 6 1945 1.November 27 1945
2. 2.
3. 3.
10. If applicant Attended any
School such as a college or university
as a duly enrolled student
while a member of the armed forces
State Length of Time of such
attendenace
Month Days
(a) In United States None None
(b) Foreign None None
11. If applicant Lost Any Time in
service by reason of AOL, AWOL,
desertion or confinement by courts
martial state length of such lost
time.
Month Days
(a) In United States None None
(b) Foreign None None
Applicant Will Not Write In The Space Below
Claim Number 222851
Warrant Number 152637
Amount Due : 297.50[?]
Date application received:
Received
Sep 7 - 1949
W. W. II Ser. Comp. Rd
Active Domestic Service
(in the United States)
Number of months 27 $ 270
Active Foreign Service
(in the United States)
Number of months 11 $27.50
Total Amount Due $297.50
Audited by
Residence approved by
Service computed by
Amounts [?] by
Recomended for [?]
Executive Secretary
Approved for Payment
[?]
(For) Campaign World War II
Service Compensation Board
Form No 1-N must be filled out and be attached to Form No.1, in all cases, if veteran served in the Navy, Marine Corps, or Coast Gaurd. THIS FORM NOT TO BE REPRODUCED
Page 1
12. Mark an "X" in the proper square to show Branch of
Service in which the applicant served.
X Army Marine Corps
Navy Coast Guard
13. Now was applicant Separated From Active Duty? Indicate
by placing an "X" in proper square.
X Discharge Retirement
Assignment to inactive status
14. (a.) Was applicant separated from active duty under
Honorable Conditions (Yes or No) Yes
(b) Did you ever refuse on conscientious, political,
religious, or other grounds to subject yourself to
military disipline? Answer Yes or No no
(c) Were you classified I-AO? Answer Yes or
No No (if answer is "Yes" to either 14b.
or 14c. attach statement of explenation.)
15. If applicant is Still On Active Duty in the armed forces of the United States the following certificate will be filed out and signed
by a commissioned officer of the armed forces of the United States who has offical custody of the service record of the applicant.
Certificate
(For applicant now in millitary service)
I. the undersigned do hereby certify that , the within named applicant is a member of my
command and in active service in an honorable status, that I have personally examined the service record of the applicant and that all of the
statements contained in said application insofar as they refer to service of the applicant in the armed forces of the United States are true and
correct as shown by the service record of the applicant.
Dated this day of , 19
Name Rank
Organization
16. If applicant registered under the Selective Service Act, state place of residence at time of registration and the number of his Local
Selctive Service Board.
House No and Street Or
R.F.D. Route No and Box No County City or Town State
3448 Avenue "B" Pott. Council Bluffs Iowa
Local Selective Service Board Number E
17. Has applicant applied to any other state for aa "bonus" or compensation based on service in World War II? (Yes or No) No
If "Yes" show name of state . Has payment been received (Yes or No) . (Amount) $
18. List millitary or naval organizations with which applicant served in World War II.
Troop "I" 1st Training Regiment, Fort Riley, Kansas.
122nd Medical Bn, 42nd Infantry Division
Also served in Iowa State Guards, HQ. Dot. at Co. Bluffs, Ia., prior to above
19. Certification - (See Instruction 19)
State of Nebraska County of Lancastor: ss.
I, Ann Miller a Notary Public in and for Lancaster County,
State of Nebraska, do herby certify that I have personally examined the discharge or certificate of service of
Clarence O. Williams
the applicant named herein that said applicant was honorably separated or discharged from the service and that said discharge or service
reord shows the following facts:
Date of entry on extended active duty March 30, 1944
Place of entry on active duty Pt. Leavenworth, Kansas
Date of discharge or separation May 3, 1946
Date of departure for foreign service January 6, 1945
Date of return from foreign service November 27, 1945
Time lost by action of Courts Martial None
Was applicant separated Honorably Yes
Dated this 2nd day of September, 1949 Ann Miller
(Name and title of Officer) Notary Public
20. State of Nebraska, County of Lancaster: ss.
I, Clarence O. Williams, beign duty sworn, state that I am the applicant named in the within
application and that each and every statement contained in said application is true and corect as I verily beileve.
Clarence O. Williams
(Applicant)
Subscribed in my presence and before me sworn to by Clarence O. Williams
on this 2nd day of September, 1919 Ann Miller
Ann Miller (Signature and title of Officer administering oath)
Read these instructions carefully. When completed, mail in a No. 10 envelope (2-fold sheet) to
World War II Service Compensation Board
124 Des Moines Street, Des Moines 16, Iowa
