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FORM 1045 REV. 2-16-31
NATIONAL OFFICERS
CENTRAL COMMITTEE
HERBERT HOOVER, PRESIDENT
JOHN BARTON PAYNE, CHAIRMAN
ROBERT w. DE FOREST, VICE PRESIDENT
MRS. AUGUST BELMONT
CALVIN COOLIDGE, VICE PRESIDENT
THE AMERICAN RED CROSS
CORNELIUS N. BLISS
MABEL T. BOARDMAN
CHARLES EVANS HUGHES. VICE PRESIDENT
JOSEPH P. COTTON
THOMAS D. THACHER, COUNSELOR
NATIONAL HEADQUARTERS
MRS. HENRY P. DAVISON
OGDEN L. MILLS, TREASURER
MRS. FRANK v. HAMMAR
MABEL T. BOARDMAN, SECRETARY
WASHINGTON, D.C.
MAJ. GEN. M. w. IRELAND
SAMUEL KNIGHT
OGDEN L. MILLS
GUSTAVUS D. POPE
NATIONAL EXECUTIVE OFFICERS
MRS. HENRY R. REA
JOHN BARTON PAYNE, CHAIRMAN
REAR ADMIRAL CHARLES E. RIGGS
JOHN D. RYAN
JAMES L. FIESER, VICE CHAIRMAN
GEORGE E. SCOTT
ERNEST P. BICKNELL, VICE CHAIRMAN
HENRY UPSON SIMS
JAMES K. Mcclintock, VICE CHAIRMAN
THOMAS D. THACHER
ELIOT WADSWORTH
9
7 QUESTIONNAIRES D2STROYEL
e
Dear Madam:
The National Committee on Red Cross Nursing Service requires us to submit,
annually, a list of all the Red Cross Nurses enrolled with our Committee, with their
latest addresses. We are extremely anxious to make a very complete report to National
Headquarters and ask for your cooperation. Please answer the following questions and
return this form to me, in enclosed envelope, at the earliest possible date.
IMPORTANT:
In order to render prompt service
Mattering
Yours sincerely,
in time of disaster, enrolled Red Cross
Chairman- or
Nurses should report at once to the
Secretary.
Secretary of the Local Committee under
which they are enrolled. Do not forget
Talrdo Ohio
the address of the Secretary.
285.3 Parkwood
Local Committee.
Name in full
Sarah Gertrude Bush
If married, give husband's name
Permanent address 4106 STREET, sfc.
Kingsbury
Toledo
Lucas
Ohio
CITY
COUNTY
STATE
Probable address for the next year
1903 monroe St
Telephone No. La 3417
STREET, ETC.
Toledo
Luces
ohio
Ma 4201
CITY
COUNTY
STATE
Name and address of nearest relative or friend, in United States, through whom you may
be communicated with in an emergency. (State relationship)
Underline the type of work
Mrs. Ella Bush same address (mother)
you are now doing: Army - Navy - U.S.P.H. Hospital - U.S. Vet. Hospital - U.S. Indian
Service - Public Health - Institutional - Private Duty - Industrial - Office Nurse -
Registrar.
Are you an instructor of Red Cross classes in Home Hygiene and Care of the Sick?
Have you ever been?
yes
Indicate present physical condition
good
20
Would you respond to an emergency call in event of epidemic, disaster, war, etc.: yes
Badge No. 20614
Current date april 3rd 1936
6
NOTE.--If the nurse does not complete and return this questionnaire, and can not be
located within two years, her enrolment will be annulled.
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"ocrText": "FORM 1045 REV. 2-16-31\nNATIONAL OFFICERS\nCENTRAL COMMITTEE\nHERBERT HOOVER, PRESIDENT\nJOHN BARTON PAYNE, CHAIRMAN\nROBERT w. DE FOREST, VICE PRESIDENT\nMRS. AUGUST BELMONT\nCALVIN COOLIDGE, VICE PRESIDENT\nTHE AMERICAN RED CROSS\nCORNELIUS N. BLISS\nMABEL T. BOARDMAN\nCHARLES EVANS HUGHES. VICE PRESIDENT\nJOSEPH P. COTTON\nTHOMAS D. THACHER, COUNSELOR\nNATIONAL HEADQUARTERS\nMRS. HENRY P. DAVISON\nOGDEN L. MILLS, TREASURER\nMRS. FRANK v. HAMMAR\nMABEL T. BOARDMAN, SECRETARY\nWASHINGTON, D.C.\nMAJ. GEN. M. w. IRELAND\nSAMUEL KNIGHT\nOGDEN L. MILLS\nGUSTAVUS D. POPE\nNATIONAL EXECUTIVE OFFICERS\nMRS. HENRY R. REA\nJOHN BARTON PAYNE, CHAIRMAN\nREAR ADMIRAL CHARLES E. RIGGS\nJOHN D. RYAN\nJAMES L. FIESER, VICE CHAIRMAN\nGEORGE E. SCOTT\nERNEST P. BICKNELL, VICE CHAIRMAN\nHENRY UPSON SIMS\nJAMES K. Mcclintock, VICE CHAIRMAN\nTHOMAS D. THACHER\nELIOT WADSWORTH\n9\n7 QUESTIONNAIRES D2STROYEL\ne\nDear Madam:\nThe National Committee on Red Cross Nursing Service requires us to submit,\nannually, a list of all the Red Cross Nurses enrolled with our Committee, with their\nlatest addresses. We are extremely anxious to make a very complete report to National\nHeadquarters and ask for your cooperation. Please answer the following questions and\nreturn this form to me, in enclosed envelope, at the earliest possible date.\nIMPORTANT:\nIn order to render prompt service\nMattering\nYours sincerely,\nin time of disaster, enrolled Red Cross\nChairman- or\nNurses should report at once to the\nSecretary.\nSecretary of the Local Committee under\nwhich they are enrolled. Do not forget\nTalrdo Ohio\nthe address of the Secretary.\n285.3 Parkwood\nLocal Committee.\nName in full\nSarah Gertrude Bush\nIf married, give husband's name\nPermanent address 4106 STREET, sfc.\nKingsbury\nToledo\nLucas\nOhio\nCITY\nCOUNTY\nSTATE\nProbable address for the next year\n1903 monroe St\nTelephone No. La 3417\nSTREET, ETC.\nToledo\nLuces\nohio\nMa 4201\nCITY\nCOUNTY\nSTATE\nName and address of nearest relative or friend, in United States, through whom you may\nbe communicated with in an emergency. (State relationship)\nUnderline the type of work\nMrs. Ella Bush same address (mother)\nyou are now doing: Army - Navy - U.S.P.H. Hospital - U.S. Vet. Hospital - U.S. Indian\nService - Public Health - Institutional - Private Duty - Industrial - Office Nurse -\nRegistrar.\nAre you an instructor of Red Cross classes in Home Hygiene and Care of the Sick?\nHave you ever been?\nyes\nIndicate present physical condition\ngood\n20\nWould you respond to an emergency call in event of epidemic, disaster, war, etc.: yes\nBadge No. 20614\nCurrent date april 3rd 1936\n6\nNOTE.--If the nurse does not complete and return this questionnaire, and can not be\nlocated within two years, her enrolment will be annulled."
}