World War records : Canton, Massachusetts, 1917-1918, Part 9

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 9
USA > Massachusetts > Norfolk County > Canton > World War records : Canton, Massachusetts, 1917-1918 > Part 9


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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Queno e


.. ...


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


americ and


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


aquitania July 5, 1 8


Port Sailed From for Overseas


new york


Date of Arrival Overseas


July 11, 1918


Port of Arrival Overseas.


South Hampton


Date and Ship Sailed Returning Home


June ,'19 Black arrow


Port Sailed from Returning Home


Barsende


Date of Arrival from Overseas.


June 16, 19


Place of Arrival in United States


Newpo


port news


Important Places Where Stationed Overseas.


Beau Desert.


Camp Hunt- Bordeaux


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. June 18, 1919


Where Discharged from Service


Camp Les Va


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. Spreman


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.


Bart Mc Sweeney, Canton


Name of Mother and Place of Residence.


Ellen


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


150 lles


Your Height in Feet and Inches.


5/ 11"


Your Complexion-White or Colored


Mute


Color of Your Eyes.


Brou


Color of Your Hair


Brown


Give Names and Addresses of Two or Three of Your Most Intimate Comrades Gardner Haman Framingham mars James Connelly milton maso Thomas Burn 2, S


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


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


Dennis


James maguire


COMPLETE DAME.


NO INITIALS.


PLEASE WRITE PLAIN


Name Dennis Q. maguire


AS APPEARS ON THE S


AVICE ROLL


Januari


1875


Date of Birth. 3 DAY


MONTH


YEAR


Place of Birth.


Savonville


mase


CITY OR TOWN


STATE OR COUNTRY Place of Residence When Entering the Service 700 Washington, Canton Mars.


STREET AND NUMBER


CITY OR TOWN


STATE


Place of Residence at Present Time ..


adame Dorchester Maso.


STREET AND NUMBER


CITY OR TOWN


STATE


Enlisted or Drafted.


Enlisted


Date and Place of Enlistment.


Date and Place Where Drafted


Date and Place Where Mustered In or Reported for Duty


Camp Taylor Ky. aug 21,18


Give Government Identification Tag Number.


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


Ordered to sail from


Hoboken for a. E 2. Oct 11,18: prevented by influenz


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


Rank While in Service.


1st Leet and Chaplain


If Commissioned Officer Give Date of Commission Sept 26, 18


If Appointed Officer Give Date of Every Appointment


If Not Overseas, Where Stationed While in Service


Camp Taylor, Ry Camp


Fremont Cal Transport service to Break Liverpool


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.


Och 7, 1919


Where Discharged from Service


Hoboken n.f


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 Serviee. Priest


Married or 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


Name of Mother and Place of Residence ....


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


yes


Give Number of Policy.


J. 4249118


What Was Your Weight When Entering the Service


175 lbs.


Your Height in Feet and Inches.


5/7'


Your Complexion-White or Colored


White


Color of Your Eyes.


Blue


Color of Your Hair


Black& gray


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


alex K. Marsden


COMPLETE NAME.


NO INITIALS. PLEASE WRITE PLAINLY


Name ....


AS APPEARS ON THE SERVICE ROLL


Date of Birthi.


DAY


MONTH YEAR


Place of Birth.


CITY OR TOWN


STATE OR COUNTRY


Place of Residence When Entering the Service 238 hehowet St Canton Mass


STREET AND NUMBER


CITY OR TOWN STATE


England


Place of Residence at Present Time. .... ....


STREET AND NUMBER CITY OR TOWN STATE


Enlisted or Drafted


Date and Place of Enlistment.


Date and Place Where Drafted.


Date and Place Where Mustered In or Reported for Duty


Give Government Identification Tag Number 40441


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


Company C, 10th Battali


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


Rank While in Service ...........


If Commissioned Officer Give Date of Commission.


If Appointed Officer Give Date of Every Appointment


If Not Overseas, Where Stationed While in Service


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. 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


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


Name of Mother and Place of Residence.


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


Color of Your Eyes.


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 Fe 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 Marshall


COMPLETE NAME. NO INITIALS. PLEASE WRITE PLAINLY


Name


Cook William marshall


AS APPEARS ON THE SERVICE ROLL march


1896


Date of Birth.


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


21


DAY


MONTH


YEAR


Place of Birth ..


........


Lucde


England


CITY OR TOWN


STATE OR COUNTRY Place of Residence When Entering the Service 624 Chapman, Carton Mare


STREET AND NJMBER


CITY OR TOWN


STATE


Place of Residence at Present Time 5.03 Chapman, Carton, Mass


STREET AND NUMBER


CITY OR TOWN


STATE


Enlisted or Drafted.


Enlisted


Date and Place of Enlistment


July 29,17. Boston maso


Date and Place Where Drafted


Date and Place Where Mustered In or Reported for Duty


July 31'17 It. Slocum, n.y


Give Government Identification Tag Number. 1409922


Co., Regt., Ship, or Service, First Assigned to and Date medical Casual Co. aug 3, 1917


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


Field Hospital #28. ambulance Co $30


Sept 28, 1917


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


Querelas


yes


Any Service in American Expeditionary Foree or Canadian or Allied Force Overseas ameri can 1 If 20, Date and Ship from the United States or Canada June 4,18 Mauretania


Port Sailed From for Overseas


Hoboken


Date of Arrival Overseas


June 11 18


Port of Arrival Overseas.


Liverpool


Date and Ship Sailed Returning Home.


July 14, 19 agamemnon


Port Sailed from Returning Home.


Break


Date of Arrival from Overseas.


July 21/19


Place of Arrival in United States


Hoboken


Important Places Where Stationed Overseas.


Le Havre Break


Luxembourge


Participated in What Battles and Dates of Same.


Vorges June 19- aug 22,18


It mihiel


Leser 12 - 16 18


meuse argonne, Oct 11 - nov 11, 18.


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 Serviee in Army or Navy before the German War if Any


When Discharged from Service. July 29, 1919.


Where Discharged from Service


Camp Devers 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. Chemist


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


James W. Marshall Canton, Max


Name of Mother and Place of Residence.


Emma


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


130 lbs


Your Height in Feet and Inches.


5'5'


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


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


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


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


Racco meninno.


....


COMPLETE NAME. NO INITIALS. PLEASE WRITE PLAINLY


Name


AS APPEARS ON THE SERVICE ROLL


Date of Birth.


8


august


1893


DAY


MONTH YEAR


Place of Birth


Grottaminarda


Italy


CITY OR TOWN


STATE OR COUNTRY


Place of Residence When Entering the Service / C. Glenwood are Hyde Park, Mass


STREET AND NUMBER


CITY OR TOWN


STATE


Place of Residence at Present Time


5 Bellavista ave, Mansfield Mass


STREET AND NUMBER


CITY OR TOWN


STATE


Enlisted or Drafted


Drafted


1. Date and Place of Enlistment June 25, 1918 Canton, mass Date and Place Where Drafted


Date and Place Where Mustered In or Reported for Duty Camp Dix M.J.


Give Government Identification Tag Number.


Co., Regt., Ship, or Service, First Assigned to and Date Co.40-10th Bat


153 rd Depat Brigade


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


Camp Din n.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. 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.


Laborer


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. alessandro Meninno, Italy


Name of Mother and Place of Residence


Mary


Italy


Are You Without the Foregoing Relatives in This Country


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


Brothers


And if so, Give Full Name and Address of Either or Both mike menino 5 Bellavista mansfield.


Charles 11. 422 n. Main St


.... ....


Have You a War Risk Insurance Policy. no


Give Number of Policy.


What Was Your Weight When Entering the Service 123/2 lbs .


Your Height in Feet and Inches.


5'3'


Your Complexion-White or Colored


White


Color of Your Eyes.


Color of Your Hair


Braun


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


Ilave 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


Harold Wesley mer


,


COMPLETE NAME. NO INITIALS. PLEASE WRITE PLAINLY


Name Harold W merriam AS APPEARS ON THE SERVICE ROLL


Date of Birth ..


June


1898


DAY


MONTH


YEAR


Place of Birth ................


Canton


mars


CITY OR TOWN


STATE OR COUNTRY


Place of Residence When Entering the Service 59 Independence Carton Maco


STREET AND NUMBER


CITY OR TOWN


STATE


Place of Residence at Present Time,


59 Independence,


STREET AND NUMBER


CITY OR TOWN


STATE


Canton Maso


Enlisted or Drafted.


Enlisted


Date and Place of Enlistment.


Canton.


Sept 30 1918


Date and Place Where Drafted.


Date and Place Where Mustered In or Reported for Duty Oct 1,18 M.J.J. Cam.


Give Government Identification Tag Number. 4908903


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


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


Boston, Maes


MIT. Cambridge, mass


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. Dec, 11, 1918.


Where Discharged from Service


MIT. 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. Clerk& 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


Walter R.Merriam, Carton, Mas


Name of Mother and Place of Residence.


Bertha E


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 150 lles


Your Height in Feet and Inches.


.... ........ 51 8 3/4"


Your Complexion-White or Colored


White


Grey


Color of Your Eyes.


Color of Your Hair


Dark.


Give Names and Addresses of Two or Three of Your Most Intimate Comrades Francis Hill, 45, Sherman Canton Maso George & Rowe, 110 Park Fall River ....... . .


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 Starry & Mittell COMPLETE NAME. NO INITIALS. PLEASE WRITE PLAINLY


Name ......


AS APPEARS ON THE SERVICE ROLL


Date of Birth. ........ DAY MONTH YEAR


Place of Birth .. .... ....


CITY OR TOWN


STATE OR COUNTRY


Place of Residence When Entering the Service 596 Washington St, Carton Mass


STREET AND NUMBER CITY OR TOWN STATE


Place of Residence at Present Time ....


STREET AND NUMBER CITY OR TOWN STATE


Enlisted or Drafted


Date and Place of Enlistment


Date and Place Where Drafted.


Date and Place Where Mustered In or Reported for Duty


Give Government Identification Tag Number. 4192134


Co., Regt., Ship, or Service, First Assigned to and Date 19 the Company, 5th Battalion 151 st Depot Brigade


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


1 Battal: What Bugade


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 Comp Devens, ayer- Mass.


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


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. Max Mittell Canton- Masa


Name of Mother and Place of Residence ..


Ida Mittell


..


.


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


Color of Your Eyes ..


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 Uniformn, 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




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