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On the envelope furnished you there will be printed the following: the fingerprints that it is the left hand instead of the right. In the case of veterans Adjusted Compensation Branch, who are mentally incapacitated, get the fingerprints, if possible. If this can not be done, as also in the case of an individual whose fingers are all missing, make a statement (The Adjutant General's Office, Bureau of to that effect in the space provided for the fingerprints. Navigation, or U. S. Marine Corps) ITEM completing item 12 either use a typewriter or print your answer plainly. It WASHINGTON, D. C. is very necessary that you do this because this part of the application will be a part of your record in the Veterans' Bureau. Just below "Adjusted Compensation Branch" you must enter the name of the office to (a) The name given in this space must be the name of the veteran, regardless of which your application is to be sent. Incase your last service was in the Army, "The whether the veteran, a legal guardian of the veteran, a dependent or legal guardian Adjutant General's Office;" in case it was in the Navy or Coast Guard, 'Bureau of of the dependent, is making application. Navigation;' in case it was in the Marine Corps, "U. S. Marine Corps. (b) In this space give your serial or service number, depending on whether your service All communications relative to service in the Coast Guard will be addressed to the was in the Army or Navy, In case you were never given a serial number Navy Department. write "None given" in the space provided for the number. If you are a de- Do not write anything in the column on the right-hand side of the application blank pendent making application and do not know the serial number of the veteran, This space is for use of War and Navy Departments and Marine Corps only. write "not known' in the space provided for serial number Read the instructions over very carefully-do not take a chance. (c) Under this item, if the veteran is dead and dependent is making application write The item number will be found in the left-hand side of the application blank. Study "Deceased" in the space provided for the veteran's address. the instructions for each item carefully before filling it in. (d) In this space will be entered the date and place of birth of the veteran regardless Be sure to answer every question. If you do not remember the information required, of who is making application. say "I do not know." Il you have any doubt as to how to go about making out your (e) The rank and organization given here will be that of the veteran at the time of application, ask some one who knows. But do not-write to the War Department, Navy discharge. If a dependent is making application and does not remember the Department, or Marine Corps. Make out your application the best you can from the last rank and organization the dependent will write "not known' in the space information at hand. provided. Follow these instructions strictly and thereby save time and trouble for everybody ITEM This item is for COMMISSIONED SERVICE ONLY. Il you do not concerned-the War and Navy Departments, the Veterans' Bureau, yourseli, and some remember exact dates give them approximately. Ii you had no commissioned service five and one-half million other veterans who are also making application for Adjusted write the word None' on the first line. Compensation and are as anxious to have their claims acted on as you are to have yours. ITEM 14. this item give the stations at which you were serving when on & commu- Be sure to fill in the space which shows whether your service was in the Army, Navy tation status, if you come in this class. If you were never on such duty write "None" Coast Guard, or Marine Corps. on the first line provided for station at which you served. Notice that the law reads ITEM 1.-Give your last name first, then your first name, followed by your middle Performing home service not with troops.' This does not apply to oversea service. name, if you have one. Be sure to give the name under which you served, although the ITEM 15.-If this item applies to you, you should give the date you started to comply records may show that name different from your true name. For instance, your name with the order granting you the furlough and the date on which you reported back to may be Greene and you may have served under the name of Green, or likewise Smyth military control. If you were ordered back from farm or industrial furlough and did and Smith. If you have your discharge certificate or certificate in lieu with you, use the not report for duty for four or five days after receipt of the order you must give the date name given thereon. Enter your serial number, or service number if you served in the you reported regardless of when you received the order. If you were discharged while Navy, in the space provided for the same. If you do not remember it or never received on farm or industrial furlough and never reported back for military duty give the date one, draw a line through the space provided for the number. This number is your Army, you stopped working. Navy, or Marine Corps serial or service number. Do not put any Veterans' Bureau ITEM -Cross out the words which do not apply. This item affects only those Claim Number or anything like that in this space. conscientious objectors who performed no military or naval duty whatever. The fact ITEM 2.--In case of a dependent making application, the address of the dependent will that you were a conscientious objector does not deprive you of benefits provided that be given. Be sure to give your house number and name of street, if same exist. If your you performed unqualified military or naval duty and did not refuse to wear the uniform. mail is delivered in care of some one, do not fail to include their name as part of your ITEM .-Cross out the words which do not apply in your case. The governing factor address. In case you have both a business and residential address, give the address of in this item is whether or not you were discharged because of alienage. Although may your residence. Do not give 'General Delivery' as an address if it is at all possible have received an honorable discharge still you are not entitled to Adjusted Compensa- to give anything more definite. Do not omit the county from your address. tion for the law specifies, Any ien-discharged from the military or naval forces on ITEM This item calls for the date of birth of the veteran, regardless of who is making account of alienage," is not entitled to the benefits accruing under this act. application. Be sure to give the city in which veteran was born if it is known. ITEM This space is provided for any statement or remark you may desire to make ITEM Be sure to give rank or grade at entrance into the service. Il you entered as and for which there is no space under any of the items of the application. a private and were later commissioned, the entry under this item would be private. ITEM 19.-In the space after the word the" in the first line of this item, insert which In the words Army," "Navy, Coast Guard, or Marine Corps" cross out the ever one of the following applies in your case, " Person' if the veteran is submitting the three in which you did not enter the service. Give the date on which you were inducted application himself; legal guardian of the person (or dependent)' if the veteran himself or, in case you enlisted, the date on which you were enlisted (not the date you were or the dependent making application is mentally incapacitated; 'widow, "widower,'9 accepted for enlistment). If you were a reser vist or an officer of the Reserve Corps, give "child,' mother,' or Tather' as the case may be, if a dependent is making applica- the date on which you started to comply with the order calling you to active duty; if tion. This statement must be signed by the person making application. No one can you don't know that date or there is any doubt, then give date on which the order di- sign for the veteran or the dependent except in case of mental incapacity when the legal rected you to report; if neither of these dates is available, give date you actually reported guardian of the veteran or dependent as the case may be will sign. In the case of a veteran for duty. If you were in the National Guard, give the date you reported for duty under or the legal guardian thereof this signature will be made in the presence of the two wit- the call of the President. Il the original entry into World War service was in the status nessesrequired to sign in item 20; in case of a dependent or legal guardian thereof the signa- of a commissioned officer, except a reserve or National Guard officer, give the date of ture will be made at the time of the oath being given and in the presence of the individual acceptance of your original commission and not the date of commission. If you were administering the oath. When the applicant is a veteran or legal guardian of a vetéran enlisted or indueted, and later commissioned, the date of original entry is the date you and is physically incapacitated, he or she will sign by making His (Her) fark in the ereenlisted or inducted and not the date of commission. In case you entered neservice presence of the witnesses required to witness the signature of the applicant in item 20; twice after April 1917, or before November 12, 1918, and your service was not continuous, if the applicant is a dependent and physically incapacitated, he or she will sign by mak- give dates of both inductions or enlistments. An example of the latter case is when a ing "His (Her) Mark in the presence of the individual who administers the oatti. in man was in the service on April 6, 1917, and discharged subsequent thereto on Surgeon's item 26. Do not omit the date under this item, space for which is on the left-hand side Certificate of Disability, and later inducted and accepted for limited military service. of the application blank which is in the left-hand side of the application. ITEM 5.-If you were an enlisted man, give the date you were separated from the en- ITEM -This item will not be filled in when a dependent is making application. listment in which you were serving on November 12, 1918, unless honorably discharged Before the persons who witness the signature of the applicant sign in the space provided before that date, in which case give the date you were separated from the service. If for their signatures, they will assure themselve that the veteran who signs the certificate you come under the class of men who did not receive a discharge certificate until a con- in item 19 is identical with the individual whose service is set forth in the application. siderable time after you left the service, give the date you left the service and not the They will also satisfy themselves that the veteran understands the statement ts made by date of the discharge certificate. him in the application and will explain to the veteran the penalty prescribi by law for ITEM --Cross out the words that do not apply to your case. Oversea service means making false or fraudulent statements therein. The addresses of the witnesses must service on shore in Europe, or Asia exclusive of China, Tapan, and the Philippine Islands. be given in this item. Service in Siberia and the Archangel Expedition counts as oversea service. Service in items 21, 22, 23, 24, 25, and 26 are to be used only in case of a dependent Hawaii, Porto Rico, Canal Zone, and Alaska does not count as being foreign vice. making application for adjusted compensation. ITEM 7.-In this item enter the names of the organizations with which you served or ITEM this item give the names, addresses, and, in case of child or children the the vessels on which you were stationed with dates in either case. If you did not belong date or dates of birth, of all persons of the indicated relationship who were dependent on to an organization or were detached from your outfit, give the name of the station at which the veteran at the time of his death. In order to be entitled to compensation under the you served. If you were sent to a hospital away from your own organization, give the provisions of the World War Adjusted Compensation Act the dependent must have been name or names of the hospitals in which you were. In case of men going oversea for dependent on the veteran at the time of said veteran's death. In case of more than service ashore and returning to the United States, do not give the name of your transport one dependent at the time of the veteran's death, they are entitled to as & vessel on which you served. The only veterans to give the name of a vessel in this in the following order: (1) Widow or widower, if unmarried; (2) children; (3) mother; item are those whose service was in the Navy or members of the Army or Marine Corps and (4) father. That is, supposing a veteran at the time of his death bad a child under assigned to duty on a vessel or transport. In case there is not sufficient space under this eighteen and also a mother dependent upon him or her for support, then the child would item for all your organizations or vessels, give the balance under " Remarks' in item 18. be entitled to the Adjusted Compensation, or if be left a widow and several children, Be sure to give your first and last organization, station or vessel. If you do not remember the widow would be entitled to the benefits under the Act provided she had not remarried the exact dates, give the approximate dates. since the death of the veteran, in which case it would go to the children. Be sure to give ITEM .-Give the character given on your discharge certificate. If you were an officer, the date or dates of birth of any children who might have been dependent on the write Officer" in the space provided for character, as no character was recorded on veteran at the time of his death. officers' discharge certificates. ITEM 22.--In the space after the word 'the" in the first line of this item insert the ITEM 9.-This item will be filled out only by men who were in the Marine Corps when relationship of the dependent to the veteran, such as widow, widower,' 'child," they sailed for oversea duty or when they returned to the United States. Il you were 'mother,' or father,' as the case may be. In the blank space after was' insert your in the Marine Corps and had no oversea duty, write the word "None" after the words age at the time of the death of the veteran. Service on" in this item. Il you had oversea service be sure to give the necessary ITEM 23.- dependent must give the address of his or her present residence. Follow names of transports, dates, and names of ports of embarkation and debarkation. the instructions under item 2 relative to the address to be given. The address under ITEM 10.-The beneficiary named by you in this item does not have to be the same as item 23 must be the same as that given under item 2. This address must be correct so the one you named in your application for War Risk Insurance, nor the nearest relative that the Departments or Bureaus charged with aeting on your claim may communicate whose name you gave at entrance into the service, but may be any person whom you with you, if necessary, and so that your Adjusted Service Pay or Adjusted Service Cer- desire to receive the benefits of your Adjusted Service Compensation in case of your tificate, if your claim is approved or notification of disallowance in case it is not allowed death. The relationship must be given in the space provided for the same. In case will reach you as soon as possible. you desire to name a friend as your beneficiary, write Friend in the space provided ITEM 24. .-The dependent will sign under this item. This signature must be identical for relationship. The signature given in this item must be identical with the signature with the signature in item 19. to the certificate in item 19. ITEM 25.-The dependent must furnish his or her fingerprints in the space provided ITEM 11.-In the rectangle set-oft on the left-hand side of the application blank, under for same in this item. For instructions relative to fingerprints see the instructions for this item, the applicant will make his (her) fingerprints. The fingerprint impression item 11, which apply to this item. of the four fingers of the right hand are to be made all at the same time after the fingers ITEM 26.-This oath is required by law for dependents and must be administered have been inked with black printer's ink, or by using a stamp pad. If possible use before the application is sent in. The individual administering the oath will assure printer's ink. It is necessary that the ridges in the print be clear and distinct other- himself that the applicant thoroughly understands the statements made in this applica- wise the application will have to be returned to you for better fingerprint impressions. tion and the penalty prescribed by law for making false or fraudulent statements It is suggested that a fingerprint impression may be obtained by going to a printing After making out your application, go back over it and check each item 80 establishment and using the roller of one of the presses as the source from which to as to be sure you have omitted nothing and that each item Is properly filled obtain the printer's ink. Fingerprints may be taken at any Army, Navy, or Marine out. Corps Recruiting Station. They may also be taken at any police station, prison, peni- A veteran making application must sign in two places-ltems 10 and 19. tentiary, reform school, or institution of that nature. In case any or all of the fingers A dependent making application must sign in two places-Items 19 and 24. of right band are gone, take an impression of the*fingers of the left hand, stating under Be sure you have signed wherever necessary. GOVERNMENT FRENTING offics Saile of from Hofoken Mar 30 1918 Ape 1919 Loaded at Bust apr 13 1918 lead apric 1919

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Type
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    "ocrText": "On the envelope furnished you there will be printed the following:\nthe fingerprints that it is the left hand instead of the right. In the case of veterans\nAdjusted Compensation Branch,\nwho are mentally incapacitated, get the fingerprints, if possible. If this can not be\ndone, as also in the case of an individual whose fingers are all missing, make a statement\n(The Adjutant General's Office, Bureau of\nto that effect in the space provided for the fingerprints.\nNavigation, or U. S. Marine Corps)\nITEM completing item 12 either use a typewriter or print your answer plainly.\nIt\nWASHINGTON, D. C.\nis very necessary that you do this because this part of the application will be a part\nof your record in the Veterans' Bureau.\nJust below \"Adjusted Compensation Branch\" you must enter the name of the office to\n(a) The name given in this space must be the name of the veteran, regardless of\nwhich your application is to be sent. Incase your last service was in the Army, \"The\nwhether the veteran, a legal guardian of the veteran, a dependent or legal guardian\nAdjutant General's Office;\" in case it was in the Navy or Coast Guard, 'Bureau of\nof the dependent, is making application.\nNavigation;' in case it was in the Marine Corps, \"U. S. Marine Corps.\n(b) In this space give your serial or service number, depending on whether your service\nAll communications relative to service in the Coast Guard will be addressed to the\nwas in the Army or Navy, In case you were never given a serial number\nNavy Department.\nwrite \"None given\" in the space provided for the number. If you are a de-\nDo not write anything in the column on the right-hand side of the application blank\npendent making application and do not know the serial number of the veteran,\nThis space is for use of War and Navy Departments and Marine Corps only.\nwrite \"not known' in the space provided for serial number\nRead the instructions over very carefully-do not take a chance.\n(c)\nUnder this item, if the veteran is dead and dependent is making application write\nThe item number will be found in the left-hand side of the application blank. Study\n\"Deceased\" in the space provided for the veteran's address.\nthe instructions for each item carefully before filling it in.\n(d) In this space will be entered the date and place of birth of the veteran regardless\nBe sure to answer every question. If you do not remember the information required,\nof who is making application.\nsay \"I do not know.\" Il you have any doubt as to how to go about making out your\n(e) The rank and organization given here will be that of the veteran at the time of\napplication, ask some one who knows. But do not-write to the War Department, Navy\ndischarge. If a dependent is making application and does not remember the\nDepartment, or Marine Corps. Make out your application the best you can from the\nlast rank and organization the dependent will write \"not known' in the space\ninformation at hand.\nprovided.\nFollow these instructions strictly and thereby save time and trouble for everybody\nITEM This item is for COMMISSIONED SERVICE ONLY. Il you do not\nconcerned-the War and Navy Departments, the Veterans' Bureau, yourseli, and some\nremember exact dates give them approximately. Ii you had no commissioned service\nfive and one-half million other veterans who are also making application for Adjusted\nwrite the word None' on the first line.\nCompensation and are as anxious to have their claims acted on as you are to have yours.\nITEM 14. this item give the stations at which you were serving when on & commu-\nBe sure to fill in the space which shows whether your service was in the Army, Navy\ntation status, if you come in this class. If you were never on such duty write \"None\"\nCoast Guard, or Marine Corps.\non the first line provided for station at which you served. Notice that the law reads\nITEM 1.-Give your last name first, then your first name, followed by your middle\nPerforming home service not with troops.' This does not apply to oversea service.\nname, if you have one. Be sure to give the name under which you served, although the\nITEM 15.-If this item applies to you, you should give the date you started to comply\nrecords may show that name different from your true name. For instance, your name\nwith the order granting you the furlough and the date on which you reported back to\nmay be Greene and you may have served under the name of Green, or likewise Smyth\nmilitary control. If you were ordered back from farm or industrial furlough and did\nand Smith. If you have your discharge certificate or certificate in lieu with you, use the\nnot report for duty for four or five days after receipt of the order you must give the date\nname given thereon. Enter your serial number, or service number if you served in the\nyou reported regardless of when you received the order. If you were discharged while\nNavy, in the space provided for the same. If you do not remember it or never received\non farm or industrial furlough and never reported back for military duty give the date\none, draw a line through the space provided for the number. This number is your Army,\nyou stopped working.\nNavy, or Marine Corps serial or service number. Do not put any Veterans' Bureau\nITEM -Cross out the words which do not apply. This item affects only those\nClaim Number or anything like that in this space.\nconscientious objectors who performed no military or naval duty whatever. The fact\nITEM 2.--In case of a dependent making application, the address of the dependent will\nthat you were a conscientious objector does not deprive you of benefits provided that\nbe given. Be sure to give your house number and name of street, if same exist. If your\nyou performed unqualified military or naval duty and did not refuse to wear the uniform.\nmail is delivered in care of some one, do not fail to include their name as part of your\nITEM .-Cross out the words which do not apply in your case. The governing factor\naddress. In case you have both a business and residential address, give the address of\nin this item is whether or not you were discharged because of alienage. Although may\nyour residence. Do not give 'General Delivery' as an address if it is at all possible\nhave received an honorable discharge still you are not entitled to Adjusted Compensa-\nto give anything more definite. Do not omit the county from your address.\ntion for the law specifies, Any ien-discharged from the military or naval forces on\nITEM This item calls for the date of birth of the veteran, regardless of who is making\naccount of alienage,\" is not entitled to the benefits accruing under this act.\napplication. Be sure to give the city in which veteran was born if it is known.\nITEM This space is provided for any statement or remark you may desire to make\nITEM Be sure to give rank or grade at entrance into the service. Il you entered as\nand for which there is no space under any of the items of the application.\na\nprivate and were later commissioned, the entry under this item would be private.\nITEM 19.-In the space after the word the\" in the first line of this item, insert which\nIn the words Army,\" \"Navy, Coast Guard, or Marine Corps\" cross out the\never one of the following applies in your case, \" Person' if the veteran is submitting the\nthree in which you did not enter the service. Give the date on which you were inducted\napplication himself; legal guardian of the person (or dependent)' if the veteran himself\nor, in case you enlisted, the date on which you were enlisted (not the date you were\nor the dependent making application is mentally incapacitated; 'widow, \"widower,'9\naccepted for enlistment). If you were a reser vist or an officer of the Reserve Corps, give\n\"child,' mother,' or Tather' as the case may be, if a dependent is making applica-\nthe date on which you started to comply with the order calling you to active duty; if\ntion. This statement must be signed by the person making application. No one can\nyou don't know that date or there is any doubt, then give date on which the order di-\nsign for the veteran or the dependent except in case of mental incapacity when the legal\nrected you to report; if neither of these dates is available, give date you actually reported\nguardian of the veteran or dependent as the case may be will sign. In the case of a veteran\nfor duty. If you were in the National Guard, give the date you reported for duty under\nor the legal guardian thereof this signature will be made in the presence of the two wit-\nthe call of the President. Il the original entry into World War service was in the status\nnessesrequired to sign in item 20; in case of a dependent or legal guardian thereof the signa-\nof a commissioned officer, except a reserve or National Guard officer, give the date of\nture will be made at the time of the oath being given and in the presence of the individual\nacceptance of your original commission and not the date of commission. If you were\nadministering the oath. When the applicant is a veteran or legal guardian of a vetéran\nenlisted or indueted, and later commissioned, the date of original entry is the date you\nand is physically incapacitated, he or she will sign by making His (Her) fark in the\nereenlisted or inducted and not the date of commission. In case you entered neservice\npresence of the witnesses required to witness the signature of the applicant in item 20;\ntwice after April 1917, or before November 12, 1918, and your service was not continuous,\nif the applicant is a dependent and physically incapacitated, he or she will sign by mak-\ngive dates of both inductions or enlistments. An example of the latter case is when\na\ning \"His (Her) Mark in the presence of the individual who administers the oatti. in\nman was in the service on April 6, 1917, and discharged subsequent thereto on Surgeon's\nitem 26. Do not omit the date under this item, space for which is on the left-hand side\nCertificate of Disability, and later inducted and accepted for limited military service.\nof the application blank which is in the left-hand side of the application.\nITEM 5.-If you were an enlisted man, give the date you were separated from the en-\nITEM -This item will not be filled in when a dependent is making application.\nlistment in which you were serving on November 12, 1918, unless honorably discharged\nBefore the persons who witness the signature of the applicant sign in the space provided\nbefore that date, in which case give the date you were separated from the service. If\nfor their signatures, they will assure themselve that the veteran who signs the certificate\nyou come under the class of men who did not receive a discharge certificate until a con-\nin item 19 is identical with the individual whose service is set forth in the application.\nsiderable time after you left the service, give the date you left the service and not the\nThey will also satisfy themselves that the veteran understands the statement ts made by\ndate of the discharge certificate.\nhim in the application and will explain to the veteran the penalty prescribi by law for\nITEM --Cross out the words that do not apply to your case. Oversea service means\nmaking false or fraudulent statements therein. The addresses of the witnesses must\nservice on shore in Europe, or Asia exclusive of China, Tapan, and the Philippine Islands.\nbe given in this item.\nService in Siberia and the Archangel Expedition counts as oversea service. Service in\nitems 21, 22, 23, 24, 25, and 26 are to be used only in case of a dependent\nHawaii, Porto Rico, Canal Zone, and Alaska does not count as being foreign vice.\nmaking application for adjusted compensation.\nITEM 7.-In this item enter the names of the organizations with which you served or\nITEM this item give the names, addresses, and, in case of child or children the\nthe vessels on which you were stationed with dates in either case. If you did not belong\ndate or dates of birth, of all persons of the indicated relationship who were dependent on\nto an organization or were detached from your outfit, give the name of the station at which\nthe veteran at the time of his death. In order to be entitled to compensation under the\nyou served. If you were sent to a hospital away from your own organization, give the\nprovisions of the World War Adjusted Compensation Act the dependent must have been\nname or names of the hospitals in which you were. In case of men going oversea for\ndependent on the veteran at the time of said veteran's death. In case of more than\nservice ashore and returning to the United States, do not give the name of your transport\none dependent at the time of the veteran's death, they are entitled to\nas & vessel on which you served. The only veterans to give the name of a vessel in this\nin the following order: (1) Widow or widower, if unmarried; (2) children; (3) mother;\nitem are those whose service was in the Navy or members of the Army or Marine Corps\nand (4) father. That is, supposing a veteran at the time of his death bad a child under\nassigned to duty on a vessel or transport. In case there is not sufficient space under this\neighteen and also a mother dependent upon him or her for support, then the child would\nitem for all your organizations or vessels, give the balance under \" Remarks' in item 18.\nbe entitled to the Adjusted Compensation, or if be left a widow and several children,\nBe sure to give your first and last organization, station or vessel. If you do not remember\nthe widow would be entitled to the benefits under the Act provided she had not remarried\nthe exact dates, give the approximate dates.\nsince the death of the veteran, in which case it would go to the children. Be sure to give\nITEM .-Give the character given on your discharge certificate. If you were an officer,\nthe date or dates of birth of any children who might have been dependent on the\nwrite Officer\" in the space provided for character, as no character was recorded on\nveteran at the time of his death.\nofficers' discharge certificates.\nITEM 22.--In the space after the word 'the\" in the first line of this item insert the\nITEM 9.-This item will be filled out only by men who were in the Marine Corps when\nrelationship of the dependent to the veteran, such as widow, widower,' 'child,\"\nthey sailed for oversea duty or when they returned to the United States. Il you were\n'mother,' or father,' as the case may be. In the blank space after was' insert your\nin the Marine Corps and had no oversea duty, write the word \"None\" after the words\nage at the time of the death of the veteran.\nService on\" in this item. Il you had oversea service be sure to give the necessary\nITEM 23.- dependent must give the address of his or her present residence. Follow\nnames of transports, dates, and names of ports of embarkation and debarkation.\nthe instructions under item 2 relative to the address to be given. The address under\nITEM 10.-The beneficiary named by you in this item does not have to be the same as\nitem 23 must be the same as that given under item 2. This address must be correct so\nthe one you named in your application for War Risk Insurance, nor the nearest relative\nthat the Departments or Bureaus charged with aeting on your claim may communicate\nwhose name you gave at entrance into the service, but may be any person whom you\nwith you, if necessary, and so that your Adjusted Service Pay or Adjusted Service Cer-\ndesire to receive the benefits of your Adjusted Service Compensation in case of your\ntificate, if your claim is approved or notification of disallowance in case it is not allowed\ndeath. The relationship must be given in the space provided for the same. In case\nwill reach you as soon as possible.\nyou desire to name a friend as your beneficiary, write Friend in the space provided\nITEM 24. .-The dependent will sign under this item. This signature must be identical\nfor relationship. The signature given in this item must be identical with the signature\nwith the signature in item 19.\nto the certificate in item 19.\nITEM 25.-The dependent must furnish his or her fingerprints in the space provided\nITEM 11.-In the rectangle set-oft on the left-hand side of the application blank, under\nfor same in this item. For instructions relative to fingerprints see the instructions for\nthis item, the applicant will make his (her) fingerprints. The fingerprint impression\nitem 11, which apply to this item.\nof the four fingers of the right hand are to be made all at the same time after the fingers\nITEM 26.-This oath is required by law for dependents and must be administered\nhave been inked with black printer's ink, or by using a stamp pad. If possible use\nbefore the application is sent in. The individual administering the oath will assure\nprinter's ink. It is necessary that the ridges in the print be clear and distinct other-\nhimself that the applicant thoroughly understands the statements made in this applica-\nwise the application will have to be returned to you for better fingerprint impressions.\ntion and the penalty prescribed by law for making false or fraudulent statements\nIt is suggested that a fingerprint impression may be obtained by going to a printing\nAfter making out your application, go back over it and check each item 80\nestablishment and using the roller of one of the presses as the source from which to\nas to be sure you have omitted nothing and that each item Is properly filled\nobtain the printer's ink. Fingerprints may be taken at any Army, Navy, or Marine\nout.\nCorps Recruiting Station. They may also be taken at any police station, prison, peni-\nA veteran making application must sign in two places-ltems 10 and 19.\ntentiary, reform school, or institution of that nature. In case any or all of the fingers\nA dependent making application must sign in two places-Items 19 and 24.\nof right band are gone, take an impression of the*fingers of the left hand, stating under\nBe sure you have signed wherever necessary.\nGOVERNMENT FRENTING offics\nSaile of from Hofoken Mar 30 1918 Ape 1919\nLoaded at Bust apr 13 1918 lead apric 1919"
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