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DUPLICATE
Form No. 200
Revised 5-15-18
to TEW and ni eniagor
AMERICAN RED CROSS
Ile to asmen ada -21
ballonn9 doidw ni
SERVICE APPLICATION FORM
,soills oil to uns TO
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.
These questions must be answered fully or the application will not be acted upon.
3
vne
01
TEW
ai
geodw
1098
auoigiler
lo
uov
Date
July 8th, 1918
sman 93618 11
on
I. Name in full
METTA P. COTTRELL
Telephone No.
PROSPECT 42 M
2. Permanent Address 3147 Prospect Avenue
Cleveland
Ohio
+
(Number and Street)
(City)
bas
Ils
to
bns
(State)
3. Temporary Address, if any, to what date
yon 36 oved
(Number and Street)
(City)
(State)
4. (a) If any changes of residence since August I, 1914, give these in full with dates
21.4
P.
(b) What is your present business or profession ?
NURSING
Name of firm or corporation with which associated FERRIS MACHINE & FOUNDRY COMPANY
(d)
Duration of Service NINETEEN MONTHS
Present Capacity
66th & Hubbard Avenue
CLEVELAND
OHIO
Business Address.
,
(Number and Street)
(City)
(State)
5. Date of Birth 1882 July 17th (a) Place of birth WILLOUGHBY OHIO
007
(Year)
(Month)
(Day)
uov (0)
(b) If of foreign birth, when and where did you arrive in the United States? -
6. If foreign born, give date and court of your naturalization
to
7. (a) Single, married or widower
SINGLE
(a) Number of Dependents NONE
(b) Full name of wife before marriage; or husband
(c) Birthplace of wife or husband
BSIN
Nationality of wife or husband
(d) Birthplace and nationality of father of wife or husband
ob (d)
(e) Birthplace and nationality of mother of wife or husband
3VIH
(f)
Full name of father
CLABE CUSHING COTTRELL
(g) Birthplace and nationality of father
WILLOUGHBY OHIO
AMERICAN
(h) If father foreign born, whether naturalized, when and where
(i) Full maiden name of mother
MARGARET JANE GARFAT
(j) Birthplace and nationality of mother
TORONTO CANADA
CANADIAN
(k) If mother foreign born, whether naturalized, when and where
(I) Full name and nationality of paternal grandfather
ASA COTTRELL
AMERICAN
a
Janoma
(m) Full maiden name and nationality of paternal grandmother
ANN HOLMES
AMERICAN
rbid
(n) Full name and nationality of maternal grandfather
WILLIAM JAMES GARFAT
ENGLISH
(0) Full maiden name and nationality of maternal grandmother MARGARET JANE KIRKPATRIC
IRISH
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 2 yrs. Supt. 50
bed
hospital; 1 yoar Public Health-Work; 2--years.factory.work, and 5 Lyears private
nursing, Charity Hospital, Hoppital (629 Eddy Road) Eddy Road Hospital; factories
Upson Nut and Ferris Machine & Fdy:Co. Visiting Nurse "ssociation all in Cleveland
Page data
- Page
- 44
- Source index
- 0
- Type
- photo
- Media ID
- e0125cc9711e5262
- Size
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Document data
- ID
- 2661279
- Core
- doc
- Type
- document
DTO data
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Context sent to Scholar
Document identity
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Document source extras
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Page context
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"ocrText": "DUPLICATE\nForm No. 200\nRevised 5-15-18\nto TEW and ni eniagor\nAMERICAN RED CROSS\nIle to asmen ada -21\nballonn9 doidw ni\nSERVICE APPLICATION FORM\n,soills oil to uns TO\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.\nThese questions must be answered fully or the application will not be acted upon.\n3\nvne\n01\nTEW\nai\ngeodw\n1098\nauoigiler\nlo\nuov\nDate\nJuly 8th, 1918\nsman 93618 11\non\nI. Name in full\nMETTA P. COTTRELL\nTelephone No.\nPROSPECT 42 M\n2. Permanent Address 3147 Prospect Avenue\nCleveland\nOhio\n+\n(Number and Street)\n(City)\nbas\nIls\nto\nbns\n(State)\n3. Temporary Address, if any, to what date\nyon 36 oved\n(Number and Street)\n(City)\n(State)\n4. (a) If any changes of residence since August I, 1914, give these in full with dates\n21.4\nP.\n(b) What is your present business or profession ?\nNURSING\nName of firm or corporation with which associated FERRIS MACHINE & FOUNDRY COMPANY\n(d)\nDuration of Service NINETEEN MONTHS\nPresent Capacity\n66th & Hubbard Avenue\nCLEVELAND\nOHIO\nBusiness Address.\n,\n(Number and Street)\n(City)\n(State)\n5. Date of Birth 1882 July 17th (a) Place of birth WILLOUGHBY OHIO\n007\n(Year)\n(Month)\n(Day)\nuov (0)\n(b) If of foreign birth, when and where did you arrive in the United States? -\n6. If foreign born, give date and court of your naturalization\nto\n7. (a) Single, married or widower\nSINGLE\n(a) Number of Dependents NONE\n(b) Full name of wife before marriage; or husband\n(c) Birthplace of wife or husband\nBSIN\nNationality of wife or husband\n(d) Birthplace and nationality of father of wife or husband\nob (d)\n(e) Birthplace and nationality of mother of wife or husband\n3VIH\n(f)\nFull name of father\nCLABE CUSHING COTTRELL\n(g) Birthplace and nationality of father\nWILLOUGHBY OHIO\nAMERICAN\n(h) If father foreign born, whether naturalized, when and where\n(i) Full maiden name of mother\nMARGARET JANE GARFAT\n(j) Birthplace and nationality of mother\nTORONTO CANADA\nCANADIAN\n(k) If mother foreign born, whether naturalized, when and where\n(I) Full name and nationality of paternal grandfather\nASA COTTRELL\nAMERICAN\na\nJanoma\n(m) Full maiden name and nationality of paternal grandmother\nANN HOLMES\nAMERICAN\nrbid\n(n) Full name and nationality of maternal grandfather\nWILLIAM JAMES GARFAT\nENGLISH\n(0) Full maiden name and nationality of maternal grandmother MARGARET JANE KIRKPATRIC\nIRISH\n8. (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 2 yrs. Supt. 50\nbed\nhospital; 1 yoar Public Health-Work; 2--years.factory.work, and 5 Lyears private\nnursing, Charity Hospital, Hoppital (629 Eddy Road) Eddy Road Hospital; factories\nUpson Nut and Ferris Machine & Fdy:Co. Visiting Nurse \"ssociation all in Cleveland"
}