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P
e
-
C
L
meaning
i
if
TS,
cto
O
L
T
of Secretary. mrs amm R Paul
the
the Name in full Dr. win C Paul
If Pormanent married, address address. give husband's for the next name no year wavo washington no Washington Tacoma Tacoma wash! wash.
Probable Telephone
and address No Proctor of nearest 3699, relative Husband Dr. wepand
Name
(State relationship)
VNNO no Washington Tacoma wn,
Underline you are now the doing: type of - work Army - Navy - U.S.P.H.Hospital - U.S.Vat. Hospital Nurse - - Registrar. Public
Health Instituional - Private Duty - Industrial - Office no
i
1
an instructor - of Red Cross classes in Home Hygieno and care of the Sick?
Are you ever been? us
Have you present physical condition. good
no
Would Indicate you respond to an emergency call in event of epid hic, disaster, war, etc. ?...
Current date may 11-19-19
Badge - the nurse does not complete and return will be this annulled. questionnaire, and can not
No. 22788
NOTE. be located If within two years, her enrollment
Form 1045
I
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&
a
5
Page data
- Page
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Document data
- ID
- 2662087
- Core
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DTO data
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