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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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    "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"
}