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QUESTI ONNAI RE
15479
Division
M with
Date July 18th 22
Z
O
1
1.
Name Melton. Nova
a
2.
Address Permanent Temporary 2018-First, St n. .St. thash D.
F
3.
Red Cross Badge Number
11543
T
4.
Date of discharge from service of 2nd 1919
Date of appointment to service July 10th 1917
a
5
5.
C
e
6.
Service with Army
Navy
S
Red Cross
U. S. Public Heal th Service Sani tary Zone
Emergency, Influenza, etc.
Epidemic, Disaster, run
7.
8.
Condition of of heal health th at on present discharge time Ear condition theme
Condition
9.
Approximate date of illness, if any, and wher e Operation minose "
10. Have you notified the Veterans' Bureau or the Red Cross Nursing Service
no
11. Are you drawing compensation from the Veterans' Bureau
no
Date granted
Number
Hospitalization, if any
Name and address of doctor/by whom examined
Hare hadtris further ferati one m nose
maspet tears since among net
12. Remarks of been under emter constructionation
"
anything 13. Vocational Training intelfrecently nence delay
Number
Where
What kind
14. Remarks Length of and course did notriceine questimmanes attains saue
mere being sent to nurses
Are you drawing insurance from American Red Cross No
5
15. the
Date granted
4
Present
occupation Follow S
N
rashing this
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