Department of Veterans Affairs

STATEMENT IN SUPPORT OF CLAIM

Privacy Act Information:

The VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of 1974 or Title 38, Code of Federal Regulations 1.576 for routine uses (i.e., civil or criminal law enorcement, congressional communications, epidemiological or research studies, the collection of money owed to the United States, litigation in which the United States is a party or has an interest, the administration of VA Programs and delivery of VA Benefits, verification of identity and status, and personnel administration) as identified in the VA System of records, 58VA21/22, Compensation, Pension, Education and Rehabilitation Records - VA, published in the Federal Register. Your obligation to respond is required to obtain or retain benefits. VA uses your SSN to identify your claim file. Providing your SSN will help ensure that your records are properly associated with your claim file. Giving us your SSN account information is voluntary. Refusal to provide your SSN by itself will not result in the denial of benefits. The VA will not deny an individual benefits for refusing to provide his or her SSN unless the disclosure of the SSN is required by Federal Statue of law in effect prior to January 1, 1975, and still in effect. The requested information considered relevant and necessary to determine maximum benefits under the law. The responses you submit are considered confidential (38 U.S.C. 5701). Information submitted is subject to verification through computer matching programs with other agencies.

 

VA Form 21-4138


________________________________________________________________________________________________________________________________________________

The following statement is made in connection with a claim for benefits in the case of the above-named Veteran:


Title: U.S. AIR FORCE MARTIAL ARTS ASSOCIATION 

http://www.airforcemartialarts.com

 

Sub Title: The Kajukenbo Self-Defense Institute 

                 http://www.uskajukenbo.com

 

I.  MSgt. Antonio Lasit USAF (Ret)

  - Military Martial Arts Exposure

 

    1928 -    Chinese "Year of the Dragon"  

                    http://en.wikipedia.org/wiki/Dragon_(zodiac)#Years_and_the_Five_Elements

 

              -    Born in Puunene, Maui, U.S. Territory Hawaii

                    http://en.wikipedia.org/wiki/Pu%CA%BBunene,_Hawaii

   

    1941 -    World War II  Pearl Harbor, U.S. Territory Hawaii

                    Japanese attack Pearl Harbor Dec. 7, 1941, bringing the U.S. to WWII.

                    http://en.wikipedia.org/wiki/Attack_on_Pearl_Harbor

          

    1943 -    American Amateur Boxing - U.S. Territory Hawaii

                    http://en.wikipedia.org/wiki/Amateur_boxing 

                    -    AAU, American Athlete Union - Hawaii 

                         http://www.aausports.org/

                         -    CYO, Catholic Youth Organization - Hawai

                               Fort Street - Chinatown, Oahu 

                               -    St. Patrick Church & School Boxing Club 

                                     http://saintpatrickhawaii.org/

 

            -      WRESTLING/JUDO - U.S. Territory, Hawaii 

                   Sensei(s): Tsutseo Rubberman Higami,  Kaimon Kudo 

 

UPDATE  -> http://ejmas.com/jalt/2007jalt/jcsart_Svinth_0701.html 

UPDATE  -> http://www.legacyofwrestling.com/index.html

 

More to come...


"I certify that the statements on this form are true and correct to the best of my knowledge and belief." 

 

ANTONIO LASIT (Name of Veteran)

U.S. AIR FORCE MARTIAL ARTS ASSOCIATION

www.airforcemartialarts.com

Publisher US Kajukenbo Association P.O. Box 322, Honolulu, Hawaii.  Copyright 2011. 


ELECTRONIC VISION ACCESS SOLUTIONS http://www.evas.com

NETWORK 614MWN1

Service: 131-289-573-89


PENALTY:  The law provides severe penalties which include fine or imprisonment, or both, for the willful submission of any statement or evidence of material fact, knowing it to be false