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San
S
M
a
J
Sufervising nevar Sou Francis eo, Hospital
F
5
Y
subeans Pedictries service is Frame 8 months
Hospital service, I rainee 5.mos. Menoral traction working
(b) Have you or your wife (or husband) at any time had business or professional relationships with subjects,
D
residing abroad, of countries now at war with the United States or its allies
10/10/20
5115
wif
ci
=
(c) State the character and extent of such business or professional intercourse
moiaivia
9. (d) Have you lived in Europe? If so, give names of European countries in which you have
ever
resided,
vd
bonili
to your wife husband lived 1919- in
France of 10, 1918
<
and respective dates of residence in each
(b) Has or ever Europe?
(c) If so, give names of European countries in which he or she has resided, and respective dates of residence
in each
(d) Have you eyey traveled in Europe? yes If so, name countries visited, with respective dates of visits.
Frames to judy 19.9-
-
(e) Has your wife or husband ever traveled in Europe?
If so, name countries which were visited,
11:
with respective dates of visits
of
as
(f)
moinsnimi If was or
Since so, August state whether I, 1914, have application you or your granted, wife (or denied husband) withdrawn applied for a Unift Groundyes States passport?
IO. (a) Have you ever been physically examined for war service? ada lo moos.
Reept stations Traphital Jan Buniers, California
so, march, 1918. Synlingaur, medical
your
SI
(b) If state when, where, and if name and address of the examining physician
(c) Were you accepted, rejected, or is the result lof the examination pending?
Respand
II. State fully your participation in the military service of the United States or its allies in the present war.
Civilipy Trospital 3 morth
Preven itrapital caning for american soldiers 3moo.
12. What previous military service have you had? State the name of the organization with which you were enrolled,
and in what branch of service, and dates of service
13. (a) If on June 5, 1917, you were under 3I years of age, state the official name and address of the Local Board
with which you were registered, and the Class and Division in which you have been placed by such Local
Board
(b) If classified in Class 5, Division G, what was found to be your physical disability?
(c) Is this disability obvious to the casual observer?
14.
(a) Names of all relatives by blood or marriage nearer than second cousins residing in Europe
(b) State the last-known place of residence of each of such persons and the business or profession in which each
of them was engaged
(c) Which of said relatives, if any, are now or have been in the military service of Germany, Austria, Bulgaria
or Turkey?
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DTO data
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