NAVEDTRA 1430/5
Stock Ordering No. 0502-LP-216-0100
PRINT OR TYPE
TITLE NAVEDTRA
NAME ADDRESS
Last First Middle Street/Ship/Unit/Division, etc.
City or FPO State Zip
RANK/RATE SSN DESIGNATOR ASSIGNMENT NO. Date Submitted:
4
4
4
4
4
USN 4
USNR 4
ACTIVE 4
INACTIVE OTHER (Specify)
1 2 3 4
T F
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
THIS FORM MAY BE LOCALLY REPRODUCED
1 2 3 4
T F
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
SCORE
1 2 3 4
T F
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
31
