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Form No. 200
Revised 2-15-18
QUADRUPLICATE
AMERICAN RED CROSS
No.
SERVICE ENROLLMENT APPLICATION
(OTHER THAN AS DOCTOR, SURGEON, OR NURSE)
Date
The questions should be answered as fully as possible, especially when an application for a passport may later be necessary.
All answers must be in handwriting of applicant.
I. Name in full
Annie Elizabeth Symonds,
Telephone No. Rhinelander 9419
2. Present Address
49 East 73rd St., N. Y. City
(Number and Street)
(City)
(State)
Sept 1014 changes of residence since August I, 1914, give these in full with dates.
Sept. 1914- Jacksonville, Fla. March 1916 Sherbrooke, Quebec.
(b) What is your present business or profession? (Be specific.)
Graduate Nurse
(Particulars at Red Gross Head quarters Wash:c.
(c) What previous business or professional experience have you had, stating nature, places and principal dates
thereof?
(d) Have you ever lived in Europe? If so, give names of European countries in which you have resided
and respective dates of residence in each.
Born in England, and lived there until coming to America Nov.1910
(e) Have you ever traveled in Europe? If so, name countries visited, with respective dates of visits.
Visited Paris August =1910
(f) Since August I, 1914, have you applied for a United States passport? If so, state whether application
was granted, denied or withdrawn.
No
3. State fully your participation in war service of U.S or any of Allies or of enemy, or in that of any state militi a
(a) Have you ever been examined for war service? If so, state when, where and, if possible, name of examin-
ing official.
Medically examined by Dr. Williamson, 49 E. 58th
(b) Were you accepted, rejected, or is result of examination pending?
Accepted
4. Date of birth August 21st 1878,
(a) Place of birth
Metfield, Suffolk, EnG.
Year
Month
Day
(b) Full name of father
John Symonds
(c) Birthplace of father
Bodingham, Suff6d Nationality of father
English
(e) If father foreign born, whether naturalized and when
(f) Full maiden name of mother
Betsy Everatt
(g) Birthplace of mother
Lincolnshire (h) Nationality of mother
English
(i) If mother foreign born, whether naturalized and when
(j) Full name and nationality of paternal grandfather
John Symonds,
English
(k) Full maiden name and nationality of paternal grandmother
Elisa Read
17
(1) Full name and nationality of maternal grandfather
John Everett
If
(m) Full maiden name and nationality of maternal grandmother
Mary Musgrave
17
(n) Names of all relatives nearer than second cousins living in Europe, specifying which of said relatives, if
any, are now or have been in the war service of Germany, Austria, Bulgaria or Turkey. State
nature and places of employment of each of such relatives not now in such war service.
No relatives nown or have ever been in war service of said
countries.
(o) Names of all relatives nearer than second cousins in the war service of any of the allies of the United States,
specifying which ally in every case.
Fred. Symonds, (brother) with B.E.Y. France
John Symonds (brother) with British Navy
Page data
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- Source index
- 0
- Type
- photo
- Media ID
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- Size
- unknown
Document data
- ID
- 2662337
- Core
- doc
- Type
- document
DTO data
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"ocrText": "Form No. 200\nRevised 2-15-18\nQUADRUPLICATE\nAMERICAN RED CROSS\nNo.\nSERVICE ENROLLMENT APPLICATION\n(OTHER THAN AS DOCTOR, SURGEON, OR NURSE)\nDate\nThe questions should be answered as fully as possible, especially when an application for a passport may later be necessary.\nAll answers must be in handwriting of applicant.\nI. Name in full\nAnnie Elizabeth Symonds,\nTelephone No. Rhinelander 9419\n2. Present Address\n49 East 73rd St., N. Y. City\n(Number and Street)\n(City)\n(State)\nSept 1014 changes of residence since August I, 1914, give these in full with dates.\nSept. 1914- Jacksonville, Fla. March 1916 Sherbrooke, Quebec.\n(b) What is your present business or profession? (Be specific.)\nGraduate Nurse\n(Particulars at Red Gross Head quarters Wash:c.\n(c) What previous business or professional experience have you had, stating nature, places and principal dates\nthereof?\n(d) Have you ever lived in Europe? If so, give names of European countries in which you have resided\nand respective dates of residence in each.\nBorn in England, and lived there until coming to America Nov.1910\n(e) Have you ever traveled in Europe? If so, name countries visited, with respective dates of visits.\nVisited Paris August =1910\n(f) Since August I, 1914, have you applied for a United States passport? If so, state whether application\nwas granted, denied or withdrawn.\nNo\n3. State fully your participation in war service of U.S or any of Allies or of enemy, or in that of any state militi a\n(a) Have you ever been examined for war service? If so, state when, where and, if possible, name of examin-\ning official.\nMedically examined by Dr. Williamson, 49 E. 58th\n(b) Were you accepted, rejected, or is result of examination pending?\nAccepted\n4. Date of birth August 21st 1878,\n(a) Place of birth\nMetfield, Suffolk, EnG.\nYear\nMonth\nDay\n(b) Full name of father\nJohn Symonds\n(c) Birthplace of father\nBodingham, Suff6d Nationality of father\nEnglish\n(e) If father foreign born, whether naturalized and when\n(f) Full maiden name of mother\nBetsy Everatt\n(g) Birthplace of mother\nLincolnshire (h) Nationality of mother\nEnglish\n(i) If mother foreign born, whether naturalized and when\n(j) Full name and nationality of paternal grandfather\nJohn Symonds,\nEnglish\n(k) Full maiden name and nationality of paternal grandmother\nElisa Read\n17\n(1) Full name and nationality of maternal grandfather\nJohn Everett\nIf\n(m) Full maiden name and nationality of maternal grandmother\nMary Musgrave\n17\n(n) Names of all relatives nearer than second cousins living in Europe, specifying which of said relatives, if\nany, are now or have been in the war service of Germany, Austria, Bulgaria or Turkey. State\nnature and places of employment of each of such relatives not now in such war service.\nNo relatives nown or have ever been in war service of said\ncountries.\n(o) Names of all relatives nearer than second cousins in the war service of any of the allies of the United States,\nspecifying which ally in every case.\nFred. Symonds, (brother) with B.E.Y. France\nJohn Symonds (brother) with British Navy"
}