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ORIGINAL
Form No. 200
Revised 5-15-18
16W
ni
aniauoo
nada
boold
vd
lla
to
ada
21
ballonns doidw ni to
AMERICAN RED CROSS
mi to vns TO
SERVICE APPLICATION FORM
Applicants for Nursing and Medical Service must accompany this form with special forms supplied by the Nursing Service and the Medical Service Bureaus
of the American Red Cross.
I
ni
TEW
oil
steqioi These questions must be answered fully or the application will not be acted upon. G BOY 91A
(D)
di
Date January 5th 1920
97638 07/11/2005 immol
I. Name in full Helen Dore Boylstone
Telephone No.
2. Permanent Address 39 Pleasant st Portemouth
nit
(Number and Street)
(City)
(State)
3. Temporary Address, if any, to what date untel Feb. 4,1920
.
99Commonweatth are Bostou mass.
(Number and Street)
(City)
(State)
4. (a) any I, these in full with
2913-1917- France. 1917-1919 (Harvard unit) 99 com. are Boston
If changes of residence since August 1914, give dates. mass. gin Hasp-Boston
(b)
What is your present business or profession? Trained nurse 1998-0-date
Name of firm or corporation with which associated Dr. E. qranville brobtree
Duration Business Address of Service. 99 year Commonwesth are Boston, Present Capacity in greating asst.
(Number and Street) of (City)
5. Date of Birth 1894 (Year) april fer (Montb (a) Place of (State) n.H
(8)
(Day)
(b) If of foreign birth, when and where did you arrive in the United States?
ndW
.OS
6. If foreign born, give date and court of your naturalization
TUOV to 91632
7. (a) Single, married or widower. risonamA to (a) Number of Dependents
(b) Full name of wife before marriage; or husband
some
c) Birthplace of wife or husband
-Need
Nationality of wife or husband
(d) Birthplace and nationality of father of wife or husband - heristory with to back (6) ss
nuoy rebiano2 uov ob nedW (d)
(e) Birthplace and nationality of mother of wife or husband -
January
(f)
(g) Birthplace and nationality of father. Duxbury, massachusetts-amrcal is
Full name of father Joseph Boylston D.M.D.
(b)
rigistol 19100 DOY bluo W
(h) If father foreign born, whether naturalized, when and where
9V198 uro bliroW (n) is
bell
as 9V193 of oldenu 71 (d)
(i) Full maiden name of mother Fannic thright
(j)
Birthplace and nationality of mother Bangor, maire american grivil nol
(k) If mother foreign born, whether naturalized, when and where
10 nonswollA
01 not wollA
Innomi Plymouth mess
(1) Full name and nationality of paternal grandfather Benjamin Boylstow
americans
(2)
(m)
doidw Dux burry americans
Full maiden name and nationality of paternal grandmother Huldah efrages
(n) Full name and nationality of maternal grandfather. Samuel wright
Full maiden name and nationality of maternal grandmother. Elvira Dore
England
(o)
W
Bangar - american
8.
(a) What previous business or professional experience have you had, stating nature, places and principal dates
thereof; the names of the firms or corporations with which you were associated 1916 and 1917
I
add
1917-/9/9-mtrance - with
1916- In charge Head penereal nurse- - mass. Clinics gen - mass. Harvard burgeal us gen. Happ bent.
8
9
Page data
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Document data
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- 2661139
- Core
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Context sent to Scholar
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Document source extras
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Page context
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"ocrText": "ORIGINAL\nForm No. 200\nRevised 5-15-18\n16W\nni\naniauoo\nnada\nboold\nvd\nlla\nto\nada\n21\nballonns doidw ni to\nAMERICAN RED CROSS\nmi to vns TO\nSERVICE APPLICATION FORM\nApplicants for Nursing and Medical Service must accompany this form with special forms supplied by the Nursing Service and the Medical Service Bureaus\nof the American Red Cross.\nI\nni\nTEW\noil\nsteqioi These questions must be answered fully or the application will not be acted upon. G BOY 91A\n(D)\ndi\nDate January 5th 1920\n97638 07/11/2005 immol\nI. Name in full Helen Dore Boylstone\nTelephone No.\n2. Permanent Address 39 Pleasant st Portemouth\nnit\n(Number and Street)\n(City)\n(State)\n3. Temporary Address, if any, to what date untel Feb. 4,1920\n.\n99Commonweatth are Bostou mass.\n(Number and Street)\n(City)\n(State)\n4. (a) any I, these in full with\n2913-1917- France. 1917-1919 (Harvard unit) 99 com. are Boston\nIf changes of residence since August 1914, give dates. mass. gin Hasp-Boston\n(b)\nWhat is your present business or profession? Trained nurse 1998-0-date\nName of firm or corporation with which associated Dr. E. qranville brobtree\nDuration Business Address of Service. 99 year Commonwesth are Boston, Present Capacity in greating asst.\n(Number and Street) of (City)\n5. Date of Birth 1894 (Year) april fer (Montb (a) Place of (State) n.H\n(8)\n(Day)\n(b) If of foreign birth, when and where did you arrive in the United States?\nndW\n.OS\n6. If foreign born, give date and court of your naturalization\nTUOV to 91632\n7. (a) Single, married or widower. risonamA to (a) Number of Dependents\n(b) Full name of wife before marriage; or husband\nsome\nc) Birthplace of wife or husband\n-Need\nNationality of wife or husband\n(d) Birthplace and nationality of father of wife or husband - heristory with to back (6) ss\nnuoy rebiano2 uov ob nedW (d)\n(e) Birthplace and nationality of mother of wife or husband -\nJanuary\n(f)\n(g) Birthplace and nationality of father. Duxbury, massachusetts-amrcal is\nFull name of father Joseph Boylston D.M.D.\n(b)\nrigistol 19100 DOY bluo W\n(h) If father foreign born, whether naturalized, when and where\n9V198 uro bliroW (n) is\nbell\nas 9V193 of oldenu 71 (d)\n(i) Full maiden name of mother Fannic thright\n(j)\nBirthplace and nationality of mother Bangor, maire american grivil nol\n(k) If mother foreign born, whether naturalized, when and where\n10 nonswollA\n01 not wollA\nInnomi Plymouth mess\n(1) Full name and nationality of paternal grandfather Benjamin Boylstow\namericans\n(2)\n(m)\ndoidw Dux burry americans\nFull maiden name and nationality of paternal grandmother Huldah efrages\n(n) Full name and nationality of maternal grandfather. Samuel wright\nFull maiden name and nationality of maternal grandmother. Elvira Dore\nEngland\n(o)\nW\nBangar - american\n8.\n(a) What previous business or professional experience have you had, stating nature, places and principal dates\nthereof; the names of the firms or corporations with which you were associated 1916 and 1917\nI\nadd\n1917-/9/9-mtrance - with\n1916- In charge Head penereal nurse- - mass. Clinics gen - mass. Harvard burgeal us gen. Happ bent.\n8\n9"
}