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ANNUAL ADDRESS QUESTIONNAIRE - Form 1045.
Name in full Hazel Bruner Nash (mrs U.S. hash
Permanent address 763 Hum oldt Street. Sanda Rosa- Caly
Probable address for the next year:
39 Impantry Post - For Sam Houston Texas
Telephone armyPart 22
Name and address of nearest relative: (State relationship) Father-
c.m. Bruner 763 Hum loldt St
Underline the type of work you are doing: Army - Navy - U.S.P.H. Hospital -
U.S. Vet. Hospital - Institutional - Public Health - Private duty - Industrial.
Are you an Instructor of Red Cross classes in Home Hygiene and Care of the Sick?
Have you ever been? no.
Illw
Would you respond to an emergency call in case of epidemic, disaster, war, etc. ? yeo
Badge number 8344
.
Current date
1917 april 1915
NOTE -- If the nurse does not complete and return this questionnaire, and cannot
be located within two years, her enrollment will be annulled.
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"ocrText": "ANNUAL ADDRESS QUESTIONNAIRE - Form 1045.\nName in full Hazel Bruner Nash (mrs U.S. hash\nPermanent address 763 Hum oldt Street. Sanda Rosa- Caly\nProbable address for the next year:\n39 Impantry Post - For Sam Houston Texas\nTelephone armyPart 22\nName and address of nearest relative: (State relationship) Father-\nc.m. Bruner 763 Hum loldt St\nUnderline the type of work you are doing: Army - Navy - U.S.P.H. Hospital -\nU.S. Vet. Hospital - Institutional - Public Health - Private duty - Industrial.\nAre you an Instructor of Red Cross classes in Home Hygiene and Care of the Sick?\nHave you ever been? no.\nIllw\nWould you respond to an emergency call in case of epidemic, disaster, war, etc. ? yeo\nBadge number 8344\n.\nCurrent date\n1917 april 1915\nNOTE -- If the nurse does not complete and return this questionnaire, and cannot\nbe located within two years, her enrollment will be annulled."
}