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D
STATEMENT OF BONDING AND INSURANCE: (36) Give a statement as to whether or not you have ever been bonded or
insured. If so, when and by whom? State whether or not a bond or insurance has ever been refused. If so, what company
refused it?
S
Life insurance by Prudential, Have never been refused insurance.
(CONLVwA) (10)
(33)
H
STATEMENT OF SERVICES IN FOREIGN GOVERNMENTS OR POLITICAL SUBDIVISIONS THEREOF: (87) V
5
TIME OF
NAMES OF
35
(37)
(14)
NAME OF
SERVICE (37b)
COMPEN-
ADDRESS (37d)
FROM-TO
SATION (37c)
PRINCIPAL (37e)
REASON FOR
COUNTRY (37a)
TERMINATION (37f)
a
ASSOCIATES
(**
(37a)
(13)
E
(37b)
-
nanvr Ok os Oik
(IS)
-
(37c)
413)
+
5
(13)
e
(DO MO. nas
(C)
(87d)
any
STATEMENT OF TIME SPENT OUTSIDE' OF THE U.S SINCE 1930: (38) notice sua resousces
to
(37e)
COUNTRY VISITED (38a)
DEPARTURE (38b)
RETURN (38 c)
REASONS FOR VISIT (38d)
(10)
our
1
cpo
dingapion pra
que
10
(37f)
(i)
u
Iu
(ii)
(A
5
(38)
asvice VMD
(3)
ço
la
of
to
(10)
(38a)
16 LOBLLIOM 18 10 v os BOMD)
(00)
with
-
-
(38b)
(ep)
Give three references, not relatives or former employers or fellow employees, who are more than thirty years of age and United States
citizens, business or professional men or women, including your family physician or your family lawyer, and (who have known you well
during the past ten years.
(d)
(03)
(33c)
NAME (39a)
RESIDENCE ADDRESS (39b)
(WIDDR
OCCUPATION
YEARS
(@0)
BUSINESS ADDRESS (39c)
KNOWN (39d)
(%
c. E. Boyer
Dawson Ave., Boonton, N.J.
(38d)
H. S. Principal
15
c. E. Evans, M.D.
144 Harrison St.
East Orange, N. J.
Doctor
(39)
S. Ratti
Fairview Ave., Boonton,
Merchant
20
(39a)
.LO: LHE
D
TEG
I
(39b)
I solemnly swear or affirm that the foregoing statements are true and complete, and the Government of the United States is authorized
I
to
investigate any information contained herein. If a material misstatement of fact should be found, it is cause for dismissal and such
other action as may be deemed appropriate. (40)
(39 c)
Ina Eleth (USUAL SIGNATURE B. Day MARK
OR OF EMPLOYEE)
WITNESS:
mercarel (USUA4. SIGNATURE ashanum OFFICIAL) Ru
(39d)
OF COMPANY OR INSTITUTION
Dir of Turnes (TITLE) Orange memorial Houp.
(40)
Subscribed to and swern to before me this
9th
day of. September
1942
(E)
Enely PUBLIC OR E.
2RCOKTEA
NOTARY OTHER PERSON AUTHORIZED TO ADMINISTER OATH
mistany Publicy m 0 OL
Y

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Document identity

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Document source extras

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Page context

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    "ocrText": "D\nSTATEMENT OF BONDING AND INSURANCE: (36) Give a statement as to whether or not you have ever been bonded or\ninsured. If so, when and by whom? State whether or not a bond or insurance has ever been refused. If so, what company\nrefused it?\nS\nLife insurance by Prudential, Have never been refused insurance.\n(CONLVwA) (10)\n(33)\nH\nSTATEMENT OF SERVICES IN FOREIGN GOVERNMENTS OR POLITICAL SUBDIVISIONS THEREOF: (87) V\n5\nTIME OF\nNAMES OF\n35\n(37)\n(14)\nNAME OF\nSERVICE (37b)\nCOMPEN-\nADDRESS (37d)\nFROM-TO\nSATION (37c)\nPRINCIPAL (37e)\nREASON FOR\nCOUNTRY (37a)\nTERMINATION (37f)\na\nASSOCIATES\n(**\n(37a)\n(13)\nE\n(37b)\n-\nnanvr Ok os Oik\n(IS)\n-\n(37c)\n413)\n+\n5\n(13)\ne\n(DO MO. nas\n(C)\n(87d)\nany\nSTATEMENT OF TIME SPENT OUTSIDE' OF THE U.S SINCE 1930: (38) notice sua resousces\nto\n(37e)\nCOUNTRY VISITED (38a)\nDEPARTURE (38b)\nRETURN (38 c)\nREASONS FOR VISIT (38d)\n(10)\nour\n1\ncpo\ndingapion pra\nque\n10\n(37f)\n(i)\nu\nIu\n(ii)\n(A\n5\n(38)\nasvice VMD\n(3)\nço\nla\nof\nto\n(10)\n(38a)\n16 LOBLLIOM 18 10 v os BOMD)\n(00)\nwith\n-\n-\n(38b)\n(ep)\nGive three references, not relatives or former employers or fellow employees, who are more than thirty years of age and United States\ncitizens, business or professional men or women, including your family physician or your family lawyer, and (who have known you well\nduring the past ten years.\n(d)\n(03)\n(33c)\nNAME (39a)\nRESIDENCE ADDRESS (39b)\n(WIDDR\nOCCUPATION\nYEARS\n(@0)\nBUSINESS ADDRESS (39c)\nKNOWN (39d)\n(%\nc. E. Boyer\nDawson Ave., Boonton, N.J.\n(38d)\nH. S. Principal\n15\nc. E. Evans, M.D.\n144 Harrison St.\nEast Orange, N. J.\nDoctor\n(39)\nS. Ratti\nFairview Ave., Boonton,\nMerchant\n20\n(39a)\n.LO: LHE\nD\nTEG\nI\n(39b)\nI solemnly swear or affirm that the foregoing statements are true and complete, and the Government of the United States is authorized\nI\nto\ninvestigate any information contained herein. If a material misstatement of fact should be found, it is cause for dismissal and such\nother action as may be deemed appropriate. (40)\n(39 c)\nIna Eleth (USUAL SIGNATURE B. Day MARK\nOR OF EMPLOYEE)\nWITNESS:\nmercarel (USUA4. SIGNATURE ashanum OFFICIAL) Ru\n(39d)\nOF COMPANY OR INSTITUTION\nDir of Turnes (TITLE) Orange memorial Houp.\n(40)\nSubscribed to and swern to before me this\n9th\nday of. September\n1942\n(E)\nEnely PUBLIC OR E.\n2RCOKTEA\nNOTARY OTHER PERSON AUTHORIZED TO ADMINISTER OATH\nmistany Publicy m 0 OL\nY"
}

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