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Form No. 200
Revised 6-4-20
AMERICAN RED CROSS
Superseding Form 249 and com-
bining with previous issue of
Form 200.
SERVICE APPLICATION FORM
All these questions must be answered fully or the application will not be acted upon.
Date Oct 12,1922
1. Name in full Christine Mercedes Nuno
Telephone No Gahla nd 2000
2. Permanent address
446 am 4. (City) City
353- S-m ave
(Number and Street)
(State)
3. Temporary address, if any, to what date
newyork City
n
(Number and Street)
4. Name, address, and relationship of person to case emergency
be notified in of (City) lilis James nuno
(State)
(Relationship)
(Name)
(Number and Street)
353-5th ave n, (City) 4. C.14
(State)
5.
(a) Date of birth (Year) aug 11, (Month) 1892
(b) Place of
(Day)
birth Buffalo my
3
(c) If foreign born, when and where did you arrive in U. S
(b
a
6. If foreign born, give date and court of your naturalization
C
7. divorced
(a) Single, married, widowed, Single (b) Number of dependents name
(b
(c) Full name of wife before marriage; or husband
(d) Birthplace of wife or husband
Nationality of wife or husband
(e) Birthplace and nationality or
of father of wife husband. Barcelana Spain
(f) Birthplace and nationality of mother of wife or
husband... Columbus Ohi 0
James
(g) Full name of father
(h) Birthplace and nationality of father Barcelana Spain
Spanic R
(i) If father foreign born, whether naturalized, when and-where
(j) Full maiden name of mother
Kate C Remingion
(k) Birthplace and nationality of mother
Columbus bho
(1) If mother foreign born, whether naturalized, when and where.
(m) Full name and nationality of paternal grandmother
Cecetia merchant Teressa R nuno
(n) Full maiden name and nationality of paternal grandmother Dtalian Citizan Xeressa Racea
(o) Full name and nationality of maternal grandfather
Kay
Jas. merchant
(p) Full maiden name and nationality of maternal grandmother Guin Carizan Cecelia Putgers
8. State schools and colleges attended, with year of graduation and degrees taken
St Teachers Hospi Tal Training Summer School Schools for hurse
Buffaes n.y. Public D. High School
P.g. John's College Hopk (Location) too
putal
(Name)
(Graduated)
(Degree)
9.
What is your present business or profession fradual hurse
Name of firm or corporation with which associated am Red Cros
Duration of service. 1919- 192 -
4.4. East 231st
Present capacity astothe nat Director. of nursing
Business address
(Number and Street)
(City)
(State)
10. (a) What previous business or professional experience have you had?
Headhurse Sighula
nurse- Church School Philapa
Head num Tbc Disp JohnsHoplains Balt SuboliTule
Headhurse
hying -in to facted n.y
asat the Director nuse Rm. Red Cross-
Chief hure army nurse Corps
(Company)
(Location)
(from-to)
(Nature of work)
11. As reference, give names and addresses of three American citizens not related to you
mn Qupur Belmont Hempsteed L.D.
Clava noyes am . RedCress was hing ton DC
Florena m. Johnson
2017 usi-
(Name)
(Number and Street)
(State)
Page data
- Page
- 16
- Source index
- 0
- Type
- photo
- Media ID
- 94c1f9b39880a8fb
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- unknown
Document data
- ID
- 2662050
- Core
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- Type
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"ocrText": "Form No. 200\nRevised 6-4-20\nAMERICAN RED CROSS\nSuperseding Form 249 and com-\nbining with previous issue of\nForm 200.\nSERVICE APPLICATION FORM\nAll these questions must be answered fully or the application will not be acted upon.\nDate Oct 12,1922\n1. Name in full Christine Mercedes Nuno\nTelephone No Gahla nd 2000\n2. Permanent address\n446 am 4. (City) City\n353- S-m ave\n(Number and Street)\n(State)\n3. Temporary address, if any, to what date\nnewyork City\nn\n(Number and Street)\n4. Name, address, and relationship of person to case emergency\nbe notified in of (City) lilis James nuno\n(State)\n(Relationship)\n(Name)\n(Number and Street)\n353-5th ave n, (City) 4. C.14\n(State)\n5.\n(a) Date of birth (Year) aug 11, (Month) 1892\n(b) Place of\n(Day)\nbirth Buffalo my\n3\n(c) If foreign born, when and where did you arrive in U. S\n(b\na\n6. If foreign born, give date and court of your naturalization\nC\n7. divorced\n(a) Single, married, widowed, Single (b) Number of dependents name\n(b\n(c) Full name of wife before marriage; or husband\n(d) Birthplace of wife or husband\nNationality of wife or husband\n(e) Birthplace and nationality or\nof father of wife husband. Barcelana Spain\n(f) Birthplace and nationality of mother of wife or\nhusband... Columbus Ohi 0\nJames\n(g) Full name of father\n(h) Birthplace and nationality of father Barcelana Spain\nSpanic R\n(i) If father foreign born, whether naturalized, when and-where\n(j) Full maiden name of mother\nKate C Remingion\n(k) Birthplace and nationality of mother\nColumbus bho\n(1) If mother foreign born, whether naturalized, when and where.\n(m) Full name and nationality of paternal grandmother\nCecetia merchant Teressa R nuno\n(n) Full maiden name and nationality of paternal grandmother Dtalian Citizan Xeressa Racea\n(o) Full name and nationality of maternal grandfather\nKay\nJas. merchant\n(p) Full maiden name and nationality of maternal grandmother Guin Carizan Cecelia Putgers\n8. State schools and colleges attended, with year of graduation and degrees taken\nSt Teachers Hospi Tal Training Summer School Schools for hurse\nBuffaes n.y. Public D. High School\nP.g. John's College Hopk (Location) too\nputal\n(Name)\n(Graduated)\n(Degree)\n9.\nWhat is your present business or profession fradual hurse\nName of firm or corporation with which associated am Red Cros\nDuration of service. 1919- 192 -\n4.4. East 231st\nPresent capacity astothe nat Director. of nursing\nBusiness address\n(Number and Street)\n(City)\n(State)\n10. (a) What previous business or professional experience have you had?\nHeadhurse Sighula\nnurse- Church School Philapa\nHead num Tbc Disp JohnsHoplains Balt SuboliTule\nHeadhurse\nhying -in to facted n.y\nasat the Director nuse Rm. Red Cross-\nChief hure army nurse Corps\n(Company)\n(Location)\n(from-to)\n(Nature of work)\n11. As reference, give names and addresses of three American citizens not related to you\nmn Qupur Belmont Hempsteed L.D.\nClava noyes am . RedCress was hing ton DC\nFlorena m. Johnson\n2017 usi-\n(Name)\n(Number and Street)\n(State)"
}