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II
Form No. 200
Revised 6-4-20
Superseding Form 249 and com-
AMERICAN RED CROSS
bining with previous issue of
Form 200.
SERVICE APPLICATION FORM
N
All these questions must be answered fully or the application will not be acted upon.
an
Mrs.
Date. 1. Name June in full 27. 1929 namie Amelia Cox Hare
ni
2. Permanent address
yost Blachmore
Telephone No.
Virginia
(b
(Number and Street)
(City)
N
(State)
3. Temporary address, if any, to what date
20 7.1929
Bein (Number college Hosp.
and Street)
(City)
Kg: (State) -
D
an
4. Name, address, and relationship of person to be notified in case of emergency
Brother
Dr. L.C. Co4
(Relationship)
(Name)
Kingport
Tema
ur
5
(Number and Street)
(City)
(State)
5. (a) Date of birth. 1.8.90
july
1.6
(b) Place of birth 70.F. Blackmore Vas...
(Year)
(Month)
(Day)
e
(c) If foreign born, when and where did you arrive in U. S
6. If foreign born, give date and court of your naturalization
7. (a) Single, married, widowed, divorced married cogarated (b) Number of dependents
none
(c) Full name of wife before marriage; or husband
(d) Birthplace of wife or husband
J.
Nationality of wife or husband
ALTI
your
car
(e) Birthplace and nationality of father of wife or husband
R.)
(f) Birthplace and nationality of mother of wife or husband
(g) Full name of father
(h) Birthplace and nationality
of father gameson m. Carolina Cox -
airlinan
(i) If father foreign born, whether naturalized, when and where
(j) Full maiden name of mother
Luta Hobba
(k) Birthplace and nationality of mother
Virginia - american
(1) If mother foreign born, whether naturalized, when and where
(m) Full name and nationality of paternal grandmother
(n) Full maiden name and nationality of paternal grandmother father
Julia wildow - american
Lennel Cox - american
(o) Full name and nationality of maternal grandfather
Calel Hobbi - american
(p) Full maiden name and nationality of maternal grandmother
8. State schools and colleges attended, with year of graduation and degrees taken
nancy salling - american
Count (scatt,ua; schools + stighschool + certificate 1911
Harrisomburg (ba) state Reachers College - graduated 19/3
Johns public (Name) Huntries Health course mainim at glarge school for peahod human college fraduated !92.3.
(Sacation)
(Graduated)
(Degree)
9. What is your present business or profession
minim 8
Name of firm or corporation with which associated
Duration of service
Present capacity
Business address
(Number and Street)
(City)
(State)
10. (a) What previous business or professional experience have you had?
to
pulalic teacher School in teachers hain Viginia and west years.
in
Visitin nume in fun school town Beva olins 1 I Hum years this
Supt. / D. Jones she Earl none and Humant Hong Johnson at Learn 2tter.
(Company) Rell Goral Disaster (Location) Relief known (from-to) in miss these hnom it -
murne Knoxville Health Ceather 1 stude months
(Nature of work)
11. As reference, give names and addresses of three American citizens not related to you
miss miss Lorena Europera Modeland Hales Visitin college musking Hou/ Blue ans. Kentucky Ohis.
miss (Name) Catherine Fgm Health Ceacher Leana
(Number and Street)
(City)
(State)
Page data
- Page
- 75
- Source index
- 0
- Type
- photo
- Media ID
- 6138a9e15ac055e8
- Size
- unknown
Document data
- ID
- 2661588
- Core
- doc
- Type
- document
DTO data
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Context sent to Scholar
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Document source metadata
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Document source extras
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"month": 7,
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Page context
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"ocrText": "II\nForm No. 200\nRevised 6-4-20\nSuperseding Form 249 and com-\nAMERICAN RED CROSS\nbining with previous issue of\nForm 200.\nSERVICE APPLICATION FORM\nN\nAll these questions must be answered fully or the application will not be acted upon.\nan\nMrs.\nDate. 1. Name June in full 27. 1929 namie Amelia Cox Hare\nni\n2. Permanent address\nyost Blachmore\nTelephone No.\nVirginia\n(b\n(Number and Street)\n(City)\nN\n(State)\n3. Temporary address, if any, to what date\n20 7.1929\nBein (Number college Hosp.\nand Street)\n(City)\nKg: (State) -\nD\nan\n4. Name, address, and relationship of person to be notified in case of emergency\nBrother\nDr. L.C. Co4\n(Relationship)\n(Name)\nKingport\nTema\nur\n5\n(Number and Street)\n(City)\n(State)\n5. (a) Date of birth. 1.8.90\njuly\n1.6\n(b) Place of birth 70.F. Blackmore Vas...\n(Year)\n(Month)\n(Day)\ne\n(c) If foreign born, when and where did you arrive in U. S\n6. If foreign born, give date and court of your naturalization\n7. (a) Single, married, widowed, divorced married cogarated (b) Number of dependents\nnone\n(c) Full name of wife before marriage; or husband\n(d) Birthplace of wife or husband\nJ.\nNationality of wife or husband\nALTI\nyour\ncar\n(e) Birthplace and nationality of father of wife or husband\nR.)\n(f) Birthplace and nationality of mother of wife or husband\n(g) Full name of father\n(h) Birthplace and nationality\nof father gameson m. Carolina Cox -\nairlinan\n(i) If father foreign born, whether naturalized, when and where\n(j) Full maiden name of mother\nLuta Hobba\n(k) Birthplace and nationality of mother\nVirginia - american\n(1) If mother foreign born, whether naturalized, when and where\n(m) Full name and nationality of paternal grandmother\n(n) Full maiden name and nationality of paternal grandmother father\nJulia wildow - american\nLennel Cox - american\n(o) Full name and nationality of maternal grandfather\nCalel Hobbi - american\n(p) Full maiden name and nationality of maternal grandmother\n8. State schools and colleges attended, with year of graduation and degrees taken\nnancy salling - american\nCount (scatt,ua; schools + stighschool + certificate 1911\nHarrisomburg (ba) state Reachers College - graduated 19/3\nJohns public (Name) Huntries Health course mainim at glarge school for peahod human college fraduated !92.3.\n(Sacation)\n(Graduated)\n(Degree)\n9. What is your present business or profession\nminim 8\nName of firm or corporation with which associated\nDuration of service\nPresent capacity\nBusiness address\n(Number and Street)\n(City)\n(State)\n10. (a) What previous business or professional experience have you had?\nto\npulalic teacher School in teachers hain Viginia and west years.\nin\nVisitin nume in fun school town Beva olins 1 I Hum years this\nSupt. / D. Jones she Earl none and Humant Hong Johnson at Learn 2tter.\n(Company) Rell Goral Disaster (Location) Relief known (from-to) in miss these hnom it -\nmurne Knoxville Health Ceather 1 stude months\n(Nature of work)\n11. As reference, give names and addresses of three American citizens not related to you\nmiss miss Lorena Europera Modeland Hales Visitin college musking Hou/ Blue ans. Kentucky Ohis.\nmiss (Name) Catherine Fgm Health Ceacher Leana\n(Number and Street)\n(City)\n(State)"
}