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Reviard 6-4-20
AMERICAN RED CROSS
Form 249 and com-
bini -ith previous issue of
Form 200.
SERVICE APPLICATION FORM
All these questions must be answered fully or the application will not be acted upon.
Dic. 15,1923
Date
1. Name in full
Raeldle M. Hiirence
Telephone No.
2. Permanent
address % L.S. Evans, Box 678 Richurond Eve
(Number and Street)
(City)
(State)
3. Temporary address, if any, to what date
(Number and Street)
(City)
of person be notified in of emergency L.S. Evans, Box 678 Richard
(State)
4. Name, address, and relationship to case
a
(Relationship)
(Name)
nov. 25 1880
(Number and Street)
(City)
(State)
5. (a) Date of birth
(b) Place of birth
(Year)
(Month)
(Day)
(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
Widowed
(b) Number of dependents
(c) Full name of wife before marriage; or husband
(d) Birthplace of wife or husband
Reading Thalles Jose Hilluou
Nationality of wife or husband
american
(e) Birthplace and nationality of father of wife or husband
american (GG not humand
(f) Birthplace and nationality of mother of wife or husband
american - (Ge not humon
(g) Full name of father
George W miller
(h) Birthplace and nationality of father
Virginia - american (as End
(i) If father foreign born, whether naturalized, when and where
(j) Full maiden name of mother
norrah E. Llayd
(k) Birthplace and nationality of mother
Virginia - american (. at not human
(1) If mother foreign born, whether naturalized, when and Avhere
(m) Full name and
nationality of paternal Isaac miller amerigan
)
(n) Full maiden name and nationality of paternal grandmother
?
"
(o) Full name and nationality of maternal grandfather
(p) Full maiden and nationality of maternal grandmother game Sturgeon
John Oevers Llayd (american/
name
"
"
8.
State schools and colleges attended ith year of graduation and degrees taken
Private schooling
Johns Hopkins Hepeted school for Nurser, Ballenion ned inaduated 1908
(Name)
Location)
(Graduated)
(Degree)
9. What is your present business or professión
nume
Name of firm or corporation with which associated,
american Red Crose
Duration of service. Action Service sure go
capacity
Business address
(Number and Street)
(City)
(State)
10.
(a) What previous business or professional experience have you had?
Have been engaged us nursing (Publis Muth) .
graduation in 1908
(Company)
(Location)
(from-to)
(Nature of work)
11. As reference, give names addresses of thrue American citizeng not related to
de CR P. figher Bound Break gunday
miss Elaie and n Larrer Sept John you N. Hip him Help Seaing Betteum School
(Name) min Careline B. La monte. Bound Mency
(Number and Street)
(City)
(State)
2
Page data
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- Source index
- 0
- Type
- photo
- Media ID
- f221cad492c0da01
- Size
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Document data
- ID
- 2661623
- Core
- doc
- Type
- document
DTO data
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Context sent to Scholar
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Page context
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"ocrText": "I\nReviard 6-4-20\nAMERICAN RED CROSS\nForm 249 and com-\nbini -ith previous issue of\nForm 200.\nSERVICE APPLICATION FORM\nAll these questions must be answered fully or the application will not be acted upon.\nDic. 15,1923\nDate\n1. Name in full\nRaeldle M. Hiirence\nTelephone No.\n2. Permanent\naddress % L.S. Evans, Box 678 Richurond Eve\n(Number and Street)\n(City)\n(State)\n3. Temporary address, if any, to what date\n(Number and Street)\n(City)\nof person be notified in of emergency L.S. Evans, Box 678 Richard\n(State)\n4. Name, address, and relationship to case\na\n(Relationship)\n(Name)\nnov. 25 1880\n(Number and Street)\n(City)\n(State)\n5. (a) Date of birth\n(b) Place of birth\n(Year)\n(Month)\n(Day)\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\nWidowed\n(b) Number of dependents\n(c) Full name of wife before marriage; or husband\n(d) Birthplace of wife or husband\nReading Thalles Jose Hilluou\nNationality of wife or husband\namerican\n(e) Birthplace and nationality of father of wife or husband\namerican (GG not humand\n(f) Birthplace and nationality of mother of wife or husband\namerican - (Ge not humon\n(g) Full name of father\nGeorge W miller\n(h) Birthplace and nationality of father\nVirginia - american (as End\n(i) If father foreign born, whether naturalized, when and where\n(j) Full maiden name of mother\nnorrah E. Llayd\n(k) Birthplace and nationality of mother\nVirginia - american (. at not human\n(1) If mother foreign born, whether naturalized, when and Avhere\n(m) Full name and\nnationality of paternal Isaac miller amerigan\n)\n(n) Full maiden name and nationality of paternal grandmother\n?\n\"\n(o) Full name and nationality of maternal grandfather\n(p) Full maiden and nationality of maternal grandmother game Sturgeon\nJohn Oevers Llayd (american/\nname\n\"\n\"\n8.\nState schools and colleges attended ith year of graduation and degrees taken\nPrivate schooling\nJohns Hopkins Hepeted school for Nurser, Ballenion ned inaduated 1908\n(Name)\nLocation)\n(Graduated)\n(Degree)\n9. What is your present business or professión\nnume\nName of firm or corporation with which associated,\namerican Red Crose\nDuration of service. Action Service sure go\ncapacity\nBusiness address\n(Number and Street)\n(City)\n(State)\n10.\n(a) What previous business or professional experience have you had?\nHave been engaged us nursing (Publis Muth) .\ngraduation in 1908\n(Company)\n(Location)\n(from-to)\n(Nature of work)\n11. As reference, give names addresses of thrue American citizeng not related to\nde CR P. figher Bound Break gunday\nmiss Elaie and n Larrer Sept John you N. Hip him Help Seaing Betteum School\n(Name) min Careline B. La monte. Bound Mency\n(Number and Street)\n(City)\n(State)\n2"
}