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Form No. 200
DUPLICATE.
Revised 2-15-18
AMERICAN RED CROSS
No
SERVICE ENROLLMENT APPLICATION
Date
s URGEONK
The questions should be answered as fully as possible, especially when an application for a passport may later be necessary.
All answers must be in handwriting of applicant,
I. Name in full Ursula Tibbels
Telephone No Kenwood 1361
2. Present Address 5210 - 12th Ave. N.E. Seattle, Washington
(Number and Street)
(City)
(State)
(a) If any changes of residence since August I, 1914, give these in full with dates.
From Washington Children' Home Route, 1, Seattle. to 5210 - 12 N.E.
(b) What is your present business or profession? (Be specific.)
Graduate Nurse
(c) What previous business or professional experience have you had, stating nature, places and principal
5
dates thereof?
3 years training in Bethany Hospital, Kansas City, Kans. 1904-1907.
b
Private Nursing 1907-1910 Physician's office nurse, 1910-1912 at
el
Bellingham, Wash. Head nurse, Washington Children's Home. Seattle 1912-1918.
(d) Have you ever lived in Europe? If so, give names of European countries in which you have resided
S
and respective dates of residence in each.
No.
(e) Have you ever traveled in Europe? If so, name countries visited, with respective dates of visits.
No.
(f) Since August I, 1914, have you applied for a United States passport? If so, state whether application
was granted, denied or withdrawn.
No..
3. State fully your participation in war service of U. S., or any of Allies or of enemy, or in that of any state
militia.
None.,
(a) Have you ever been examined for war service? If so, state when, where and, if possible, name of ex-
amining official.
No.
(b) Were you accepted, rejected, or is result of examination pending?
4. Date of birth1883
, April
23rd
(a) Place of birth Grant City, Missouri.
,
Year
Month
Day
(b) Full name of father. Thomas C. Tibbels,
(c) Birthplace of father Ohio.
(d) Nationality of father American
(e) If father foreign born, whether naturalized and when
(f) Full maiden name of mother Anna. Rebecca Holiday
(g) Birthplace of mother Ohio
(h) Nationality of mother American
(i) If mother foreign born, whether naturalized and when
(j) Full name and nationality of paternal grandfather Jacob Tibbels -- American
(k) Full maiden name and nationality of paternal grandmother Margeret Brison. -- American.
(1) Full name and nationality of maternal grand father James Temple Holiday - -American.
(m) Full maiden name and nationality of maternal grandmother Rebecca Walmesly -- American.
(n)
Names of all relatives nearer than second cousins living in Europe, specifying which of said relatives,
if any, are now or have been in the war service of Germany, Austria, Bulgaria or Turkey. State
nature and places of employment of each of such relatives not now in such war service.
None.
(o) Names of all relatives nearer than second cousins in the war service of any of the allies of the United
States, specifying which ally in every case.
None.
Page data
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"ocrText": "N\nA\na\ne\nForm No. 200\nDUPLICATE.\nRevised 2-15-18\nAMERICAN RED CROSS\nNo\nSERVICE ENROLLMENT APPLICATION\nDate\ns URGEONK\nThe questions should be answered as fully as possible, especially when an application for a passport may later be necessary.\nAll answers must be in handwriting of applicant,\nI. Name in full Ursula Tibbels\nTelephone No Kenwood 1361\n2. Present Address 5210 - 12th Ave. N.E. Seattle, Washington\n(Number and Street)\n(City)\n(State)\n(a) If any changes of residence since August I, 1914, give these in full with dates.\nFrom Washington Children' Home Route, 1, Seattle. to 5210 - 12 N.E.\n(b) What is your present business or profession? (Be specific.)\nGraduate Nurse\n(c) What previous business or professional experience have you had, stating nature, places and principal\n5\ndates thereof?\n3 years training in Bethany Hospital, Kansas City, Kans. 1904-1907.\nb\nPrivate Nursing 1907-1910 Physician's office nurse, 1910-1912 at\nel\nBellingham, Wash. Head nurse, Washington Children's Home. Seattle 1912-1918.\n(d) Have you ever lived in Europe? If so, give names of European countries in which you have resided\nS\nand respective dates of residence in each.\nNo.\n(e) Have you ever traveled in Europe? If so, name countries visited, with respective dates of visits.\nNo.\n(f) Since August I, 1914, have you applied for a United States passport? If so, state whether application\nwas granted, denied or withdrawn.\nNo..\n3. State fully your participation in war service of U. S., or any of Allies or of enemy, or in that of any state\nmilitia.\nNone.,\n(a) Have you ever been examined for war service? If so, state when, where and, if possible, name of ex-\namining official.\nNo.\n(b) Were you accepted, rejected, or is result of examination pending?\n4. Date of birth1883\n, April\n23rd\n(a) Place of birth Grant City, Missouri.\n,\nYear\nMonth\nDay\n(b) Full name of father. Thomas C. Tibbels,\n(c) Birthplace of father Ohio.\n(d) Nationality of father American\n(e) If father foreign born, whether naturalized and when\n(f) Full maiden name of mother Anna. Rebecca Holiday\n(g) Birthplace of mother Ohio\n(h) Nationality of mother American\n(i) If mother foreign born, whether naturalized and when\n(j) Full name and nationality of paternal grandfather Jacob Tibbels -- American\n(k) Full maiden name and nationality of paternal grandmother Margeret Brison. -- American.\n(1) Full name and nationality of maternal grand father James Temple Holiday - -American.\n(m) Full maiden name and nationality of maternal grandmother Rebecca Walmesly -- American.\n(n)\nNames of all relatives nearer than second cousins living in Europe, specifying which of said relatives,\nif any, are now or have been in the war service of Germany, Austria, Bulgaria or Turkey. State\nnature and places of employment of each of such relatives not now in such war service.\nNone.\n(o) Names of all relatives nearer than second cousins in the war service of any of the allies of the United\nStates, specifying which ally in every case.\nNone."
}