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11
ORIGINAL
Form No. 200
Revised 5-15-18
TBW
and
ni
entigues
boold
yd
asvinsion
lls
to
add
AMERICAN RED CROSS
bollows
doidy
mi
to VAS 10
SERVICE APPLICATION FORM
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.
V'ne
Date
march 28? n 1919
231
firmal
I. Name in full
Mina n Whelming Kirr
Telephone No.
birth 1462
2. Permanent Address
beard 1631 (Number 9, and Street (qua) Frhm Prescription (City)
D.G.
brts
3. Temporary Address, no if any, to what date. 1631 q. It Machigan
(State)
D.L.
(Number and Street)
(City)
(State)
4. (a)
RESITEMA
If any changes of residence since August I, I914, him give these in full lite with dates mg1914 address 100V May (a) 1. 1917
426 East 26? II
(b) What is your present business or profession?
you
Univer
be
Name of firm or corporation with which associated a American Rid has
Duration of Service. t misml time Present Capacity. Bursau Hind
Business
Address: Red lass- 177-oz. (ity) It (State) D.L.
(Number and Street)?
5. Date of Birth 1865 Dr. 24 (a) Place of birth
(Year)
(Month)
(Day)
himbargh
(b) If of foreign birth, when and where did you arrive in the United States?
agsignal
agistol
y.
10
6. If foreign born, give date and court of your naturalization
dogg sghalword may to
7. (a) Single, married OF widower for enssitio sands 10 (a) Number of Dependents
(b) Full name of wife before marriage; or husband
(c) Birthplace of wife or husband
Nationality of wife or husband
(d) Birthplace and nationality of father of wife or husband
visionizing
F. sehhold JUOY rabianoo Inv Joney (6)
(e) Birthplace and nationality of mother of wife or husband
Insthurgh J. yrs
(f) Full name of father Brooger Mashington Kess
VIIG
(g) Birthplace and nationality of father
Firshold my Jersey
(h) If father foreign born, whether naturalized, when and where
(i) Full
maiden name of mother mangaget Ladlow h.
(j)
Birthplace and nationality of mother 03 gaivil
107
(k) If mother foreign born, whether naturalized, when and where motinu 107 TO gonewollA
107
sonswollA
(I) Full from name and nationality of paternal grandfather grains of N.S.A
tapome
Justy
(m) Full maiden name and nationality of eaternal grand mother
many Bullman U.S.
didn (n) Full name and nationality of maternal grandfather. Rr. John Bramn WIth
(o) Full
maiden Born name Mor and nationality your of maternal Lty grandmother flog Frances Indlaw
N.S.h. from h.y Mater
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
James numero
have Inclu- Billions Hospital - h. y hty 1902 -1904
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- Source index
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- Type
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Document data
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- Core
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"ocrText": "11\nORIGINAL\nForm No. 200\nRevised 5-15-18\nTBW\nand\nni\nentigues\nboold\nyd\nasvinsion\nlls\nto\nadd\nAMERICAN RED CROSS\nbollows\ndoidy\nmi\nto VAS 10\nSERVICE APPLICATION FORM\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.\nV'ne\nDate\nmarch 28? n 1919\n231\nfirmal\nI. Name in full\nMina n Whelming Kirr\nTelephone No.\nbirth 1462\n2. Permanent Address\nbeard 1631 (Number 9, and Street (qua) Frhm Prescription (City)\nD.G.\nbrts\n3. Temporary Address, no if any, to what date. 1631 q. It Machigan\n(State)\nD.L.\n(Number and Street)\n(City)\n(State)\n4. (a)\nRESITEMA\nIf any changes of residence since August I, I914, him give these in full lite with dates mg1914 address 100V May (a) 1. 1917\n426 East 26? II\n(b) What is your present business or profession?\nyou\nUniver\nbe\nName of firm or corporation with which associated a American Rid has\nDuration of Service. t misml time Present Capacity. Bursau Hind\nBusiness\nAddress: Red lass- 177-oz. (ity) It (State) D.L.\n(Number and Street)?\n5. Date of Birth 1865 Dr. 24 (a) Place of birth\n(Year)\n(Month)\n(Day)\nhimbargh\n(b) If of foreign birth, when and where did you arrive in the United States?\nagsignal\nagistol\ny.\n10\n6. If foreign born, give date and court of your naturalization\ndogg sghalword may to\n7. (a) Single, married OF widower for enssitio sands 10 (a) Number of Dependents\n(b) Full name of wife before marriage; or husband\n(c) Birthplace of wife or husband\nNationality of wife or husband\n(d) Birthplace and nationality of father of wife or husband\nvisionizing\nF. sehhold JUOY rabianoo Inv Joney (6)\n(e) Birthplace and nationality of mother of wife or husband\nInsthurgh J. yrs\n(f) Full name of father Brooger Mashington Kess\nVIIG\n(g) Birthplace and nationality of father\nFirshold my Jersey\n(h) If father foreign born, whether naturalized, when and where\n(i) Full\nmaiden name of mother mangaget Ladlow h.\n(j)\nBirthplace and nationality of mother 03 gaivil\n107\n(k) If mother foreign born, whether naturalized, when and where motinu 107 TO gonewollA\n107\nsonswollA\n(I) Full from name and nationality of paternal grandfather grains of N.S.A\ntapome\nJusty\n(m) Full maiden name and nationality of eaternal grand mother\nmany Bullman U.S.\ndidn (n) Full name and nationality of maternal grandfather. Rr. John Bramn WIth\n(o) Full\nmaiden Born name Mor and nationality your of maternal Lty grandmother flog Frances Indlaw\nN.S.h. from h.y Mater\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\nJames numero\nhave Inclu- Billions Hospital - h. y hty 1902 -1904"
}