World War records : Canton, Massachusetts, 1917-1918, Part 17

Author: Canton (Mass.). Town Clerk
Publication date: 1917
Publisher: The Town
Number of Pages: 634


USA > Massachusetts > Norfolk County > Canton > World War records : Canton, Massachusetts, 1917-1918 > Part 17
USA > Massachusetts > Norfolk County > Canton > World War records : Canton, Massachusetts, 1917-1918 > Part 17


Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).


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If so, Date and Ship from the United States or Canada


Port Sailed From for Overseas


Date of Arrival Overseas Port of Arrival Overseas.


Date and Ship Sailed Returning Home


Port Sailed from Returning Home.


Date of Arrival from Overseas.


Place of Arrival in United States


Important Places Where Stationed Overseas


Participated in What Battles and Dates of Same.


Wounded or Other Injuries Received in Action, Place and Date


If Confined in Hospital, During What Time and Place


If Prisoner by Enemy, Date and Place of Capture


Places Confined


Date and Place Released


Give Record of Service in Army or Navy before the German War if Any


When Discharged from Service.


Dec. 19. 1918


Where Discharged from Service


For What Reason Discharged from Service.


Demobilization


If Given Medal of Honor, Give Action and Date .... ..........


If Given Citation or Certificate of Merit, Give Service and Date


Other Medals and Foreign Decorations


Kind of Occupation Before War Service. motor man


Married or Single married


If Ever Married, Maiden Name of Wife (or Wives) mande Grafton


Date and Place of Marriage to Wife (or Wives) Canton. april 30, 1919


Date and Place of Death of Wife (or Wives)


If Any Divorce, Date and Place Where Granted.


If Married was Your Wife Ever Married Before Married to You


no


If So, Name of Former Husband, and Date and Place of His Death or Divorce


Names, Ages and Places of Birth of All Children, if any


Name of Father and Place of Residence.


andrew Seaman, Pugwash, n.S.


Name of Mother and Place of Residence marga garet ",


Are You Without the Foregoing Relatives in This Country


If So, Have You a Brother or Sister Here.


4


And if so, Give Full Name and Address of Either or Both


James


Seaman 7 Depot, Fitchburg Mass


Have You a War Risk Insurance Policy


no.


Give Number of Policy.


What Was Your Weight When Entering the Service 137 lbs.


Your Height in Feet and Inches


...... 51 6 1/4"


Your Complexion-White or Colored white


Color of Your Eyes ..


Bacon


Color of Your Hair


Give Names and Addresses of Two or Three of Your Most Intimate Comrades


....


Have You a Photograph of Self, in Service Uniform, to Give Town


If Foregoing Record is of One Deceased, Give Date of Death


Give Place of Death and Place of Burial. Give Burial Lot Number


Any Monument or Headstone Marked to Deceased Where Buried


Any Memorial for Deceased in Other Cemetery Than Where Buried


If Grave is Unmarked Will Permission be Given to Set a Government Headstone


Name and Address of Person Filling Out This Record of Deceased


REMARKS. (Please give here any matter of interest relating to Your Service.)


GERMAN WAR SERVICE RECORD of Canton, Mass.


Semer


Name nochem COMPLETE NAME. NO INITIALS. PLEASE WRITE PLAINLY


Name


.......


AS APPEARS ON THE SERVICE ROLL


Date of Birth


23


aug.


1893


DAY


MONTH


YEAR


Place of Birth


Big


Kunnea


Russia


CITY OR TOWN


STATE OR COUNTRY


Place of Residence When Entering the Service.


58 Talman Canton Mass.


STREET AND NUMBER


CITY OR TOWN


STATE


Place of Residence at Present Time ...


73 ave "O" new york, ny.


STREET AND NUMBER


CITY OR TOWN


STATE


Enlisted or Drafted. Drafted


Date and Place of Enlistment


Date and Place Where Drafted


Canton Mage


Date and Place Where Mustered In or Reported for Duty


Sept 6, 1918


Give Government Identification Tag Number.


4903792


Co., Regt., Ship, or Service, First Assigned to and Date


103 Co.25 Recruit Batt.


Other Regiments, Ships or Branches of Services, Transferred to and Dates.


Camp Hancock, Ga., Oct 27


Sheffield, ala. Ordnance Dept. Nov1,


Rank While in Service.


Private


If Commissioned Officer Give Date of Commission ............


If Appointed Officer Give Date of Every Appointment


If Not Overseas, Where Stationed While in Service


Syracuse n.4


- Sheffield, ala


Any Service in American Expeditionary Force or Canadian or Allied Force Overseas


If so, Date and Ship from the United States or Canada


Port Sailed From for Overseas Date of Arrival Overseas Port of Arrival Overseas


Date and Ship Sailed Returning Home.


Port Sailed from Returning Home ..


Date of Arrival from Overseas.


Place of Arrival in United States


Important Places Where Stationed Overseas.


Participated in What Battles and Dates of Same


Wounded or Other Injuries Received in Action, Place and Date


If Confined in Hospital, During What Time and Place


If Prisoner by Enemy, Date and Place of Capture.


Places Confined


Date and Place Released


Give Record of Service in Army or Navy before the German War if Any


When Discharged from Service. march 26, 1919


Where Discharged from Service


muscle Shoals ala


...


For What Reason Discharged from Service.


Demobilization


If Given Medal of Honor, Give Action and Date .. ......


.... ........ If Given Citation or Certificate of Merit, Give Service and Date


Other Medals and Foreign Decorations


Kind of Occupation Before War Service.


Married or Single Single


If Ever Married, Maiden Name of Wife (or Wives)


Date and Place of Marriage to Wife (or Wives)


Date and Place of Death of Wife (or Wives)


If Any Divorce, Date and Place Where Granted


If Married was Your Wife Ever Married Before Married to You


If So, Name of Former Husband, and Date and Place of His Death or Divorce


Names. Ages and Places of Birth of All Children, if any


Name of Father and Place of Residence.


morduch Semer Russi.


Name of Mother and Place of Residence.


anna


Are You Without the Foregoing Relatives in This Country


yes


If So. Have You a Brother or Sister Here.


Eyes


And if so, Give Full Name and Address of Either or Both


may. Semer. Benny Semer ...... 18 Second auburn marie


Have You a War Risk Insurance Policy.


Give Number of Policy.


What Was Your Weight When Entering the Service 138 lbo.


Your Height in Feet and Inches. 5'2'


Your Complexion-White or Colored


Dark


Color of Your Eyes.


Braun


Color of Your Hair


Black


Give Names and Addresses of Two or Three of Your Most Intimate Comrades P. Gordon Canton masa


max Meyers, Boston


Have You a Photograph of Self, in Service Uniform, to Give Town


If Foregoing Record is of One Deceased, Give Date of Death


Give Place of Death and Place of Burial


Give Burial Lot Number. ....


Any Monument or Headstone Marked to Deceased Where Buried


Any Memorial for Deceased in Other Cemetery Than Where Buried


If Grave is Unmarked Will Permission be Given to Set a Government Headstone.


Name and Address of Person Filling Out This Record of Deceased.


REMARKS. (Please give here any matter of interest relating to Your Service. )


GERMAN WAR SERVICE RECORD of Canton, Mass.


Name John George


Shaw


COMPLETE NAME. NOGNITIALS. PLEASE WRITE PLAINLY


Name John George AS APPEARS ON THE SERVICE ROLL


Shaw


Date of Birth.


.29


april


1889


DAY


MONTH


YEAR


England


Place of Birth


CITY OR TOWN


STATE OR COUNTRY


Place of Residence When Entering the Service. .614 Chapman, Carton, Mass STREET AND NUMBER CITY OR TOWN STATE


Place of Residence at Present Time.


Decrase.


STREET AND NUMBER CITY OR TOWN STATE


Enlisted or Drafted.


Enlisted


Date and Place of Enlistment.


Canada


Date and Place Where Drafted


Date and Place Where Mustered In or Reported for Duty


Give Government Identification Tag Number.


Co., Regt., Ship, or Service, First Assigned to and Date D. C. 41st Batt. C. 6. 2.


Other Regiments, Ships or Branches of Services, Transferred to and Dates


Rank While in Service.


Private


If Commissioned Officer Give Date of Commission .......


If Appointed Officer Give Date of Every Appointment


If Not Overseas, Where Stationed While in Service Mag ara -ou- Lake Overseas


Any Service in American Expeditionary Force or Canadian or Allied Force Overseas Canadian


If so, Date and Ship from the United States or Canada


Port Sailed From for Overseas


Quebec


Date of Arrival Overseas


Port of Arrival Overseas.


Plymouth Eng


Date and Ship Sailed Returning Home


Port Sailed from Returning Home.


Date of Arrival from Overseas.


Place of Arrival in United States


Important Places Where Stationed Overseas.


Participated in What Battles and Dates of Same.


Wounded or Other Injuries Received in Action, Place and Date


If Confined in Hospital. During What Time and Place 1.


If Prisoner by Enemy, Date and Place of Capture. Places Confined


Date and Place Released


Give Record of Service in Army or Navy before the German War if Any


When Discharged from Service. Where Discharged from Service


For What Reason Discharged from Service. ............. ....


If Given Medal of Honor, Give Action and Date. ......... ....


If Given Citation or Certificate of Merit, Give Service and Date Other Medals and Foreign Decorations


Kind of Occupation Before War Service.


Married or Single Single


If Ever Married, Maiden Name of Wife (or Wives)


Date and Place of Marriage to Wife (or Wives)


Date and Place of Death of Wife (or Wives)


If Any Divorce, Date and Place Where Granted


If Married was Your Wife Ever Married Before Married to You


If So, Name of Former Husband, and Date and Place of His Death or Divorce


Names. Ages and Places of Birth of All Children, if any ..


Name of Father and Place of Residence


George n. Shaw England


Name of Mother and Place of Residence


Betsey


........


Are You Without the Foregoing Relatives in This Country


If So. Have You a Brother or Sister Here .. .........


And if so, Give Full Name and Address of Either or Both


Have You a War Risk Insurance Policy.


Give Number of Policy. ..................


What Was Your Weight When Entering the Service


Your Height in Feet and Inches.


Your Complexion-White or Colored white


Color of Your Eyes. ............


Blue


Color of Your Hair Brown


Give Names and Addresses of Two or Three of Your Most Intimate Comrades


Have You a Photograph of Self, in Service Uniform, to Give Town If Foregoing Record is of One Deceased, Give Date of Death June 13,16 Reported missing Give Place of Death and Place of Burial Upres - Lille-beck


Give Burial Lot Number. no.


Any Monument or Headstone Marked to Deceased Where Buried


no


Any Memorial for Deceased in Other Cemetery Than Where Buried


If Grave is Unmarked Will Permission be Given to Set a Government Headstone.


Name and Address of Person Filling Out This Record of Deceased.


REMARKS. (Please give here any matter of interest relating to Your Service.) Left Dover, Eng. for France May 5, 1916.


GERMAN WAR SERVICE RECORD of Canton, Mass.


Name


Russell Westcott


Shaw


COMPLETE NAME. NO INITIALS. PLEASE WRITE PLAINLY


Name


AS APPEARS ON THE SERVICE ROLL


Date of Birth


28


august


1892


DAY


MONTH


YEAR


Place of Birth


Central Grave Digly on.


CITY OR TOWN


STATE OR COUNTRY


Place of Residence When Entering the Service.


39 Nach, Canton Mass


STREET AND NUMBER


CITY OR TOWN


STATE


Place of Residence at Present Time.


Sharon.


mass.


STREET AND NUMBER


CITY OR TOWN


STATE


Enlisted or Drafted.


Drafted


Date and Place of Enlistment.


Date and Place Where Drafted.


Canton Oct 5, 1917.


Date and Place Where Mustered In or Reported for Duty


Och 8, 1917


Give Government Identification Tag Number


1922751


Co., Regt., Ship, or Service, First Assigned to and Date Co.A. 302 Auf. Depot Brig.


Other Regiments, Ships or Branches of Services, Transferred to and Dates. 3 th Co. Jet Training Batt, 157 Depot Brig


Co. C. 514 Engineers.


Service Batt


,


Rank While in Service.


Private Sergeant


If Commissioned Officer Give Date of Commission


If Appointed Officer Give Date of Every Appointment


If Not Overseas, Where Stationed While in Service


Camps Deveno Mass


Camp Gordon Ga.


Any Service in American Expeditionary Force or Canadian or Allied Force Overseas ameri can


yes


If so, Date and Ship from the United States or Canada


Port Sailed From for Overseas


newport news, Va.


Date of Arrival Overseas


may 13, 1918


Port of Arrival Overseas.


Bordeaux


Date and Ship Sailed Returning Home.


May 13, 1917 Von Steuben


Port Sailed from Returning Home.


Brest


Date of Arrival from Overseas.


June 6, 1917


Place of Arrival in United States


Hoboken


Important Places Where Stationed Overseas.


Participated in What Battles and Dates of Same. .......


Wounded or Other Injuries Received in Action, Place and Date


If Confined in Hospital, During What Time and Place Challan France July 6, 18, Camp Gordon Dec. 19, 1917.


.... If Prisoner by Enemy, Date and Place of Capture.


Places Confined


Date and Place Released


Give Record of Service in Army or Navy before the German War if Any


When Discharged from Service


June 28, 1919


Where Discharged from Service


Campo Deveno


For What Reason Discharged from Service


If Given Medal of Honor, Give Action and Date


If Given Citation or Certificate of Merit, Give Service and Date


Other Medals and Foreign Decorations


Kind of Occupation Before War Service. milk Dealer


Married or Single


married


If Ever Married, Maiden Name of Wife (or Wives)


Beatrice andrews


Date and Place of Marriage to Wife (or Wives) Shar mass


Date and Place of Death of Wife (or Wives)


If Any Divorce, Date and Place Where Granted


If Married was Your Wife Ever Married Before Married to You


If So, Name of Former Husband, and Date and Place of His Death or Divorce


Names. Ages and Places of Birth of All Children, if any


Name of Father and Place of Residence


John A. Shaw nova Scotia


Name of Mother and Place of Residence ..


Effic Westcott


11


Are You Without the Foregoing Relatives in This Country


If So, Have You a Brother or Sister Here.


And if so, Give Full Name and Address of Either or Both


ITave You a War Risk Insurance Policy.


Give Number of Policy


What Was Your Weight When Entering the Service


154 lho.


Your Height in Feet and Inches


5/ 8 1/4"


Your Complexion-White or Colored


Light


Color of Your Eyes.


Blue


Color of Your Hair


Bland


Give Names and Addresses of Two or Three of Your Most Intimate Comrades Fred Pallen new york andrew Brocheau New Hartford, Conn. Laurence Stilsan Brockton mass


Have You a Photograph of Self, in Service Uniform, to Give Town


If Foregoing Record is of One Deceased, Give Date of Death


Give Place of Death and Place of Burial


Give Burial Lot Number. .............


Any Monument or Headstone Marked to Deceased Where Buried


Any Memorial for Deceased in Other Cemetery Than Where Buried


If Grave is Unmarked Will Permission be Given to Set a Government Headstone


Name and Address of Person Filling Out This Record of Deceased.


REMARKS. (Please give here any matter of interest relating to Your Service.)


GERMAN WAR SERVICE RECORD of Canton, Mass.


Name


John Francia


Shea


COMPLETE NAME. NO INITIALS. PLEASE WRITE PLAINLY


Name


John Francis


Shea


AS APPEARS ON THE SERVICE ROLL


September


1892


. .


Date of Birth.


26


DAY


MONTH


YEAR


Place of Birth.


..............


Elmira


n.4


CITY OR TOWN


STATE OR COUNTRY


Place of Residence When Entering the Service 19


Crane


Canton, masa


STREET AND NUMBER


CITY OR TOWN


STATE


Place of Residence at Present Time /12/2 North


Salem mass


STREET AND NUMBER


CITY OR TOWN


STATE


Enlisted or Drafted.


Drafted


Date and Place of Enlistment


Date and Place Where Drafted


Oct 4, 1917.


Salem, mass


Date and Place Where Mustered In or Reported for Duty


Oct 4, Camp Devenue


Give Government Identification Tag Number.


1675878


Co., Regt., Ship, or Service, First Assigned to and Date


17 th. Co. 5th Bu. Depot


Brig Camp Devens Oct 4, 1917.


Other Regiments, Ships or Branches of Services, Transferred to and Dates. medical Detach June 7,1918 Camp Devena mass


Rank While in Service ..


Private.


La't med. Det.


If Commissioned Officer Give Date of Commission


If Appointed Officer Give Date of Every Appointment


If Not Overseas, Where Stationed While in Service.


Camp Deveno mass


Any Service in American Expeditionary Force or Canadian or Allied Force Overseas 2


If so, Date and Ship from the United States or Canada Port Sailed From for Overseas Date of Arrival Overseas Port of Arrival Overseas.


Date and Ship Sailed Returning Home.


Port Sailed from Returning Home.


Date of Arrival from Overseas.


Place of Arrival in United States


Important Places Where Stationed Overseas


Participated in What Battles and Dates of Same


Wounded or Other Injuries Received in Action, Place and Date


If Confined in Hospital, During What Time and Place


If Prisoner by Enemy, Date and Place of Capture.


Places Confined


Date and Place Released


Give Record of Service in Army or Navy before the German War if Any


......


When Discharged from Service. July 19 1919


Where Discharged from Service Camp Devens, mass


For What Reason Discharged from Service .. Demobilization


If Given Medal of Honor, Give Action and Date.


If Given Citation or Certificate of Merit, Give Service and Date Other Medals and Foreign Decorations


Kind of Occupation Before War Service.


manager Grocery Store


Married or Single Single


If Ever Married, Maiden Name of Wife (or Wives)


Date and Place of Marriage to Wife (or Wives).


Date and Place of Death of Wife (or Wives)


If Any Divorce, Date and Place Where Granted


If Married was Your Wife Ever Married Before Married to You


If So, Name of Former Husband, and Date and Place of His Death or Divorce


Names, Ages and Places of Birth of All Children, if any


Name of Father and Place of Residence.


Dan D. Shea Mitth, So Boston


Name of Mother and Place of Residence.


Are You Without the Foregoing Relatives in This Country


no


If So. Have You a Brother or Sister Here .. ......


And if so, Give Full Name and Address of Either or Both


Have You a War Risk Insurance Policy.


no


Give Number of Policy ....


What Was Your Weight When Entering the Service


51 6'


126 lbs


Your Height in Feet and Inches.


Your Complexion-White or Colored


white


Color of Your Eyes.


Blue


Color of Your Hair


Light Brown


Give Names and Addresses of Two or Three of Your Most Intimate Comrades Joseph Kelley, Litchfield, Conn George alquim, Hardy, Salem mass Thomas OBrien Greenfield mass


Have You a Photograph of Self, in Service Uniform, to Give Town


If Foregoing Record is of One Deceased, Give Date of Death


Give Place of Death and Place of Burial. .... Give Burial Lot Number.


Any Monument or Headstone Marked to Deceased Where Buried


Any Memorial for Deceased in Other Cemetery Than Where Buried


If Grave is Unmarked Will Permission be Given to Set a Government Headstone


Name and Address of Person Filling Out This Record of Deceased.


REMARKS. (Please give here any matter of interest relating to Your Service.)


GERMAN WAR SERVICE RECORD of Canton, Mass.


Name


David William Sheehan


COMPLETE NAME. NO INITIALS. PLEASE WRITE PLAINLY


Name


David Williams


Sheehan


AS APPEARS ON THE SERVICE ROLL


Date of Birth.


.....


25


march


1891


DAY


MONTH


YEAR


Place of Birth


Brockton


mare


CITY OR TOWN


STATE OR COUNTRY


Place of Residence When Entering the Service 479 Wach. Canton Mass


STREET AND NUMBER


CITY OR TOWN


STATE


Place of Residence at Present Time .:


479 Wash Canton Mars


STREET AND NUMBER


E


CITY OR TOWN


STATE


Enlisted or Drafted.


Drafted


Date and Place of Enlistment.


Date and Place Where Drafted


Canton. april 27, 1918


Date and Place Where Mustered In or Reported for Duty apr. 27. Camp Devene


Give Government Identification Tag Number. 1692597


Co., Regt., Ship, or Service, First Assigned to and Datec


24th. Depot Brigade


Other Regiments, Ships or Branches of Services, Transferred to and Dates.


304th. Jul, Co B. Special Duty. army School


of the Line


Rank While in Service.


Private


If Commissioned Officer Give Date of Commission.


If Appointed Officer Give Date of Every Appointment


If Not Overseas, Where Stationed While in Service


Queraças


Any Service in American Expeditionary Force or Canadian or Allied Force Overseas American


If so, Date and Ship from the United States of Canada Salthybius July 8/8


Port Sailed From for Overseas


Charlestown


Date of Arrival Overseas


July 23, 1918


Port of Arrival Overseas.


Southampton


Date and Ship Sailed Returning Home


march 3,'19 Mt Vernon


Port Sailed from Returning Home.


Brest


Date of Arrival from Overseas.


march 11, '19


Place of Arrival in United States


new york


Important Places Where Stationed Overseas.


Langres


Participated in What Battles and Dates of Same


Wounded or Other Injuries Received in Action, Place and Date


If Confined in Hospital, During What Time and Place


If Prisoner by Enemy, Date and Place of Capture .. ....... ........


Places Confined


Date and Place Released


Give Record of Service in Army or Navy before the German War if Any


When Discharged from Service. april 5- 1919


Where Discharged from Service


Camp Divers


For What Reason Discharged from Service ..


Demobilization


If Given Medal of Honor, Give Action and Date.


If Given Citation or Certificate of Merit, Give Service and Date


Other Medals and Foreign Decorations


Kind of Occupation Before War Service. Clerk.


Married or Single Single


If Ever Married, Maiden Name of Wife (or Wives)


Date and Place of Marriage to Wife (or Wives)


Date and Place of Death of Wife (or Wives)


If Any Divorce, Date and Place Where Granted


If Married was Your Wife Ever Married Before Married to You


If So, Name of Former Husband, and Date and Place of His Death or Divorce


Names, Ages and Places of Birth of All Children, if any


..


Name of Father and Place of Residence.


David Sheehan (Deceased)


Name of Mother and Place of Residence


Hannah


Canton


Are You Without the Foregoing Relatives in This Country


no


If So, Have You a Brother or Sister Here .. .....


And if so, Give Full Name and Address of Either or Botlı


Have You a War Risk Insurance Policy.


no


Give Number of Policy.


What Was Your Weight When Entering the Service


164 lbs


Your Heiglit in Feet and Inclies.


5/11'


Your Complexion-White or Colored


White


Color of Your Eyes.


Blue


Color of Your Hair


Black


Give Names and Addresses of Two or Three of Your Most Intimate Comrades


Have You a Photograph of Self, in Service Uniform, to Give Town no


If Foregoing Record is of One Deceased, Give Date of Death


Give Place of Death and Place of Burial


Give Burial Lot Number.


Any Monument or Headstone Marked to Deceased Where Buried


Any Memorial for Deceased in Other Cemetery Than Where Buried


If Grave is Unmarked Will Permission be Given to Set a Government Headstone


Name and Address of Person Filling Out This Record of Deceased.


REMARKS. (Please give here any matter of interest relating to Your Service.) .......


GERMAN WAR SERVICE RECORD of Canton, Mass.


Name


William


вашицен.


Shorter


COMPLETE NAME. NO INITIALS. PLEASE WRITE PLAINLY


Name


William


8 Shorter


AS APPEARS ON THE SERVICE ROLL


Date of Birth.


27


January


1886


DAY


MONTH


YEAR


Place of Birth.


Skipton yorkshire England


CITY OR TOWN


STATE OR COUNTRY


Place of Residence When Entering the Service 27/ Walpole, Canton Mare


STREET AND NUMBER CITY OR TOWN STATE


Place of Residence at Present Time. 27/ Walpole, Canton Mass


STREET AND NUMBER


CITY OR TOWN


STATE


Enlisted or Drafted.


Enlisted


Date and Place of Enlistment.


Boston


June 8, 1917


Date and Place Where Drafted.


Date and Place Where Mustered In or Reported for Duty


June 8, 1917


Give Government Identification Tag Number. 1027


Co., Regt., Ship, or Service, First Assigned to and Date


Co B. Mc Lean Vilties 236th Batt


Other Regiments, Ships or Branches of Services, Transferred to and Dates.


13 the Canadian Railway Troops


Rank While in Service.


Private


If Commissioned Officer Give Date of Commission


If Appointed Officer Give Date of Every Appointment


If Not Overseas, Where Stationed While in Service


Queralas


Any Service in American Expeditionary Force or Canadian or Allied Force Overseas Imperial Territoriales


yes


If so, Date and Ship from the United States or Canada


Port Sailed From for Overseas


montreal.


Date of Arrival Overseas


Nov 28, 1917


Port of Arrival Overseas.


Liverpool


Date and Ship Sailed Returning Home.


metagamia apr. 23, 1919


Port Sailed from Returning Home


Liverpool


Date of Arrival from Overseas.


may 3, 1919


Quebec


Place of Arrival in United States


Important Places Where Stationed Overseas.


Seaford, Purfleet


Liverpool, Boston- Eng


Participated in What Battles and Dates of Same ..


Wounded or Other Injuries Received in Action, Place and Date


If Confined in Hospital, During What Time and Place


7th. Can. Gen. Hoop.


Etaples France, aug 3, 1918


If Prisoner by Enemy, Date and Place of Capture.


Places Confined


Date and Place Released


Give Record of Service in Army or Navy before the German War if Any


When Discharged from Service.


May 3, 1919


Where Discharged from Service


quebec


For What Reason Discharged from Service.


Demobilization


If Given Medal of Honor, Give Action and Date. .... ..............


If Given Citation or Certificate of Merit, Give Service and Date


Other Medals and Foreign Decorations


Kind of Occupation Before War Service. Painter + Decorater


Married or Single ..............


Married


If Ever Married, Maiden Name of Wife (or Wives) nellie Dael


Date and Place of Marriage to Wife (or Wives) Mar: 23' 18. Slough Bucks Eng.


Date and Place of Death of Wife (or Wives) .....


If Any Divorce, Date and Place Where Granted.


If Married was Your Wife Ever Married Before Married to You


no.


If So, Name of Former Husband, and Date and Place of His Death or Divorce


Names, Ages and Places of Birth of All Children, if any


....


Name of Father and Place of Residence.


arthur Shorter Yorkshire, Eng


La Name of Mother and Place of Residence Emily


Are You Without the Foregoing Relatives in This Country


If So, Have You a Brother or Sister Here ..


And if so, Give Full Name and Address of Either or Both


Have You a War Risk Insurance Policy.




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