World War records : Canton, Massachusetts, 1917-1918, Part 21

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 21
USA > Massachusetts > Norfolk County > Canton > World War records : Canton, Massachusetts, 1917-1918 > Part 21


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).


Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24


Your Complexion-White or Colored


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


Blue


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 yes


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 northend Tenney


COMPLETE NAME. NO INITIALS. PLEASE WRITE PLAINLY


Name William n. Tenney AS APPEARS ON THE SERVICE ROLL


Date of Birth.


....


17


Чертания.


1869


DAY MONTH YEAR


Place of Birth.


Georgetown


CITY ØR TOWN


STATE OR COUNTRY


mass


Place of Residence When Entering the Service. 756 Wash, Canton Maso


STREET AND NUMBER CITY OR TOWN STATE


Place of Residence at Present Time .. ' 756 Wask. Canton Mass


STREET AND NUMBER CITY OR TOWN STATE


Enlisted or Drafted Drafted


Date and Place of Enlistment


Date and Place Where Drafted Com, Officer, aug 5, 1917


Date and Place Where Mustered In or Reported for Duty July 31, 1917


Give Government Identification Tag Number.


Co., Regt., Ship, or Service, First Assigned to and Date Com. Off. mar 27,17 2. Hosp. $1. 101 st Duild Hoop


Other Regiment, Ships or Branches of Services, Transferred to and Dates. last. Corps Surg. 1st army Corps. Feb 1918. Regt Sung 2nd Eng. Sept 1918. Quiero Nov.'18. Break July 3' 19.


Rank While in Service. major


If Commissioned Officer Give Date of Commission. march 27, 1917


If Appointed Officer Give Date of Every Appointment


If Not Overseas, Where Stationed While in Service


Querser


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


yes


If so, Date and Ship from the United States or Canada Hewy mallory, Sept 7, 1917


Port Sailed From for Overseas


Hoboken


Date of Arrival Overseas


Sept 21, 1917


Port of Arrival Overseas


St nazaire


Date and Ship Sailed Returning Home.


Qua 319 Imperator


Port Sailed from Returning Home.


Brest


Date of Arrival from Overseas.


aug 10, 1919


Place of Arrival in United States


Hoboken


Important Places Where Stationed Overseas.


It Nazaire, Bazvilles Meuse


Liffal-le-Grand, Langues- neufchateau,


Chateau Thierry- Villeneaux, Ardennes St malo


Participated in What Battles and Dates of Same. 2nd marne - Chateau Thierry July-aug, 1918 Ir mihiel. Sept 1917.


Champagne


Sept- Och 1918


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 Nat Guard, magg, 1889-90 1909-1917.


When Discharged from Service august 26. 1919


Where Discharged from Service


Camp Dix


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 Deeorations


Kind of Occupation Before War Service Physician


Married or Single


married


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


Grace L. Holmes


Date and Place of Marriage to Wife (or Wives)


aug 12 '96 Canton


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


..


Constance Canton. apr. 28'98. Marian,


Canton Nov 12'02. Rosamond Canton, apr 14,05


Charles N Tenney, Georgetown, Mass.


Name of Father and Place of Residence.


Sarah


Name of Mother and Place of Residence.


Are You Without the Foregoing Relatives in This Country


(Deceased)


If So, Have You a Brother or Sister Here.


yes


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


Dred Tenny Winthrop mars


Have You a War Risk Insurance Policy.


yes


Give Number of Policy.


1,551676


What Was Your Weight When Entering the Service


13.8 lbs


Your Height in Feet and Inches.


5'6'


Your Complexion-White or Colored


White


Color of Your Eyes.


.....


Blue


Color of Your Hair


Dark


Give Names and Addresses of Two or Three of Your Most Intimate Comrades Robert S. Manda. U. S army .....


James & Hall .. J. C. Hardwick, M. D. Quincy 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 Decease 1.


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


GERMAN WAR SERVICE RECORD of Canton, Mass.


Name Arthur Wendell Thomas


COMPLETE NAME. NO INITIALS. PLEASE WRITE PLAINLY


Name arthur N. Thomas


AS APPEARS ON THE SERVICE ROLL


Date of Birth ..


2


march


1897


DAY


MONTH


YEAR


Canton


mage


Place of Birth.


....


CITY OR TOWN


STATE OR COUNTRY


Place of Residence When Entering the Service. 96 Prospect Canton Mass


STREET AND NUMBER


CITY OR TOWN


STATE


Place of Residence at Present Time.


Deceased


STREET AND NUMBER CITY OR TOWN STATE


Enlisted or Drafted. Enlisted


Nov 1914


Date and Place of Enlistment


Re-Enlisted


1917.


Date and Place Where Drafted ......


Date and Place Where Mustered In or Reported for Duty Mar. 25,17 Camp mc Guinness


Give Government Identification Tag Number. 63102


Co., Regt .. Ship, or Service, First Assigned to and Date 101st Ind.


26th. Div mar 25.1917


Other Regiments, Ships or Branches of Services, Transferred to and Dates Supply Co. 101 st Ind


Rank While in Service.


.....


...... Cook


If Commissioned Officer Give Date of Commission


If Appointed Officer Give Date of Every Appointment


If Not Overseas, Where Stationed While in Service


Querendo


...


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


yes


ameri can


If so, Date and Ship from the United States or Canada Sept 8, 17 adriatic


Port Sailed From for Overseas


New york


Date of Arrival Overseas


Sept 1917


Port of Arrival Overseas. Liverpool


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 .. Rubenville, Chesney, Meu-le-Tout


Participated in What Battles and Dates of Same. Chemin des Dames Feb 1918. Tout apr, 1918. Chateau Thierry July 1918. Verdun Oct 1 918 argonne


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


mainar Quand mexico 1916


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. Leather Worker


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


Thomas 8. Thomas.


Canton


Name of Mother and Place of Residence many 11 (Deceased)


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.


Give Number of Policy.


What Was Your Weight When Entering the Service


155 lho .


Your Height in Feet and Inches.


516'


Your Complexion-White or Colored


White


Color of Your Eyes. ....


Brown


......


Color of Your Hair


Give Names and Addresses of Two or Three of Your Most Intimate Comrades If n Brown Cohasset Mare


Richard Butter So Boston


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


If Foregoing Record is of One Deceased, Give Date of Death Dec 22 1918


Give Place of Death and Place of Burial. La Bourboule France Give Burial Lot Number. .....


Any Monument or Headstone Marked to Deceased Where Buried


Any Memorial for Deceased in Other Cemetery Than Where Buried Flag in Canton Cemetery


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


Name and Address of Person Filling Out This Record of Deceased. George E Thomas Canton Mass


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


GERMAN WAR SERVICE RECORD of Canton, Mass.


Name George Edward Thomas


COMPLETE NAME. NO INITIALS. PLEASE WRITE PLAINLY


Name George E. Thomas


AS APPEARS ON THE SERVICE ROLL


....... 12 December 1891


Date of Birth.


.....


DAY MONTH YEAR


Place of Birth.


........


Canton


mass


CITY OR TOWN


STATE OR COUNTRY


Place of Residence When Entering the Service 096 Prospect Canton, mase


STREET AND NUMBER


CITY OR TOWN


STATE


Place of Residence at Present Tim


de2 Messinger Canton Maso


STREET AND NUMBER CITY OR TOWN STATE


Enlisted or Drafted.


Enlisted


Date and Place of Enlistment.


July 10, 17 Charlestown


Date and Place Where Drafted


Date and Place Where Mustered In or Reported for Duty July 1 0,17 Boston


Give Government Identification Tag Number. 63093


Co., Regt., Ship, or Service, First Assigned to and Date 5 th mass Supply Co


Other Regiments, Ships or Branches of Services, Transferred to and Dates. Supply Cp. 101 st. Ouf


Rank While in Service.


Wagoner


If Commissioned Officer Give Date of Commission.


If Appointed Officer Give Date of Every Appointment


If Not Overseas, Where Stationed While in Service


Newport News


Quera


eas


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


yes


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


Ellosentia nov 1.0.17


Port Sailed From for Overseas


Newport news


Date of Arrival Overseas


Dec 7, 1917


Port of Arrival Overseas.


St nazaire


Date and Ship Sailed Returning Home.


mar 289 america


Port Sailed from Returning Home


Break


Date of Arrival from Overseas.


april 5, 1919


Place of Arrival in United States


Boston


Important Places Where Stationed Overseas.


Rubenville Chesney Men le Paul


Participated in What Battles and Dates of Same.


Cheman de Dame


Deb 18. Tout april 1918, Chateau


Thierry July 1918. Verdun Oct 1918.


argonne


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 28. 1919


Where Discharged from Service


Camp Devenus


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. Leather finisher


Married or Single married


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


martha & miller


Date and Place of Marriage to Wife (or Wives)


Noxupad Dec 10, ' 19


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.


Thomas & Thomas, Canton


Name of Mother and Place of Residence.


mary


11


(Deceased)


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


What Was Your Weight When Entering the Service


5 / 4 3 /4"


150 las.


Your Height in Feet and Inches.


Your Complexion-White or Colored


White


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


Brown


Color of Your Hair


Black


Give Names and Addresses of Two or Three of Your Most Intimate Comrades alton Carter. Cambridge masa


Golden. Dorchester, Mass


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 Walter francis Titus


COMPLETE NAME. NO INITIALS. PLEASE WRITE PLAINLY


Name malter 8. Titus


AS APPEARS ON THE SERVICE ROLL


Date of Birth.


3


DAY


Jun


e


1893


MONTH


YEAR


Place of Birth


....


Canton


mass


CITY OR TOWN


STATE OR COUNTRY


Place of Residence When Entering the Service 306 Mask, Canton Mass


STREET AND NUMBER CITY OR TOWN STATE


Place of Residence at Present Time 1306 Wash. Canton Mass


STATE


Enlisted or Drafted Enlisted


STREET AND NUMBER CITY OR TOWN Boston,


Date and Place of Enlistment


June 14, 1917


Date and Place Where Drafted


Date and Place Where Mustered In or Reported for Duty Recruiting Sta. Boston June 14.


Give Government Identification Tag Number.


Co., Regt., Ship, or Service, First Assigned to and Date 7th Co. U. S. navy,


Electrical Class


Other Regiments, Ships or Branches of Services, Transferred to and Dates Mine laying forces, Brandenburg, Louisville. 4 Base 17-18


Rank While in Service. Electrician 3/c


If Commissioned Officer Give Date of Commission.


If Appointed Officer Give Date of Every Appointment


If Not Overseas, Where Stationed While in Service


Overseas


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


yes


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


Gloucestershire, aug 12,18


Port Sailed From for Overseas


Halifax


Date of Arrival Overseas


aug 26, 18


Port of Arrival Overseas.


Glasgow


Date and Ship Sailed Returning Home


may 22'19 Lamiville


Port Sailed from Returning Home.


Liverpool


Date of Arrival from Overseas.


June 1,'19


Place of Arrival in United States


Hoboken


Important Places Where Stationed Overseas.


Base 18 Inverness


Base #17 almeno


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 Influenza


Base 17×18 Hospitals


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 20 1919


Where Discharged from Service


Hingham


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.


Electrician


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.


Frederick Titus Canton,


Name of Mother and Place of Residence Emma 4


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.


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


What Was Your Weight When Entering the Service


5' 18 3 /4"


142 lbs.


Your Height in Feet and Inches.


Your Complexion-White or Colored white


Color of Your Eyes.


Hazel


Color of Your Hair


Brown


Give Names and Addresses of Two or Three of Your Most Intimate Comrades Rodney Reed Colebrook n. H Frederic Kinder, Marblehiel miss DI, West Highland ave Norfolk, Va


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


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 liere any matter of interest relating to Your Service.)


ha submarine aug 1918, off coast of Geland, Sank arabic


GERMAN WAR SERVICE RECORD of Canton, Mass.


Name


Gilbert Talman


COMPLETE NAME. NO INITIALS. PLEASE WRITE PLAINLY


Name Gilbert Talman Jr.


AS APPEARS ON THE SERVICE ROLL


Date of Birth. ............. 23 December


DAY


MONTH


1897


YEAR


Place of Birth


Canton


CITY OR TOWN


mass


STATE OR COUNTRY Place of Residence When Entering the Service 95 Rockland, Cantou Mass.


STREET AND NUMBER


CITY OR TOWN


STATE


Place of Residence at Present Time.


95 Rockland, Canton, Mass


STREET AND NUMBER CITY OR TOWN STATE


Enlisted or Drafted.


Enlisted


Date and Place of Enlistment


Boston Navy Yard, July 30, 1918.


Date and Place Where Drafted ....


Date and Place Where Mustered In or Reported for Duty Sept 4, Bumpkins Os


Give Government Identification Tag Number.


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


U. S. n. P. S.


Other Regiment=, Ships or Branches of Services, Transferred to and Dates


Officina


material School, Dec 2018


Takefield Nov 22 - Dec 2018


Rank While in Service apprentice Seaman Ensign


If Commissioned Officer Give Date of Commission. april 19, 1919


If Appointed Officer Give Date of Every Appointment


If Not Overseas, Where Stationed While in Service Pumpkins Is Wakefield, Cambridge Officers School


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. april 19, 19.19


Where Discharged from Service


Cambridge


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. Student


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


Gilbert Talman, Canton


Name of Mother and Place of Residence


Helen


.V. 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


Have You a War Risk Insurance Policy


no.


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


What Was Your Weight When Entering the Service


5' 10'


145 lbs


Your Height in Feet and Inches.


Your Complexion-White or Colored


White


Color of Your Eyes ..


Color of Your Hair


Brawn


Give Names and Addresses of Two or Three of Your Most Intimate Comrades Charles . Kimball, Cambridge mago Frederick Lockwood, Manchester n.H. Scott Keith, Greenfield maso


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


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 Villa May Jeffrey Garner COMPLETE DADE. NO INITIALS. PLEASE WRITE PLAINLY


Name Villa May Jeffrey AS FARS ON THE SERVICE ROLL


Date of Birth 30th September


DAY MONTH YEAR


1886


nova Scotia Place of Birth Digby CITY OR TOWN STATE OR COUNTRY Place of Residence When Entering the Service $ 65 High St. Canton Mass.


STREET AND NUMBER CITY OR TOWN STATE


Place of Residence at Present Time. le Meridian, Mississippi Box 800


STREET AND NUMBER CITY OR TOWN STATE


Enlisted or Drafted. Enlisted


Date and Place of Enlistment Seht 28.1917


Canton. Mass


Date and Place Where Drafted


Date and Place Where Mustered In or Reported for Duty Oct. 3-1917 Camp Sevier - Greenville S.C.


Give Government Identification Tag Number.


Co., Regt., Ship, or Service, First Assigned to and Date army Nunca Corp Oct. 3-1917


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


Rank While in Service.


army nurse


If Commissioned Officer Give Date of Commission.


If Appointed Officer Give Date of Every Appointment


If Not Overseas, Where Stationed While in Service


Camp Servies Svemille - 2.C.


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 14 1919


Where Discharged from Service


Camp Sevier Greemille S. C.


For What Reason Discharged from Service.


Illness at home


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


Other Medals and Foreign Decorations


Kind of Oeeupation Before War Service .... , Superintendent of hospital


Married or Single Single at time of service


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 IIis Death or Divorce


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


..


Name of Father and Place of Residence


albert O. Jeffrey, Bloomfield, Digly Co. Nova Scotia


..


Name of Mother and Place of Residence


Charlate S. Treffeny.


Are You Without the Foregoing Relatives in This Country


If So, Have You a Brother or Sister Here


Tua brothers


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


John a. Jeffrey, Washington


Willis At Treffrey, Stratford new Stampshine


Have You a War Risk Insurance Poliey.


Give Number of Poliey


T 725011


What Was Your Weight When Entering the Service


120 lbs


Your Height in Feet and Inches.


5ft. 21/2 fiches


Your Complexion-White or Colored


White


Color of Your Eyes.


Gray


Color of Your Hair


Blanke


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 Reeord 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 Le Given to Set a Government Headstone.




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