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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