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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)

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75
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0
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photo
Media ID
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ID
2661588
Core
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Context sent to Scholar

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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)"
}