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Samuel Warhaftig's Application for Admittance to JCRS, between 1904 September 16-1906 October 20

 Item
Identifier: B002.01.0097.0016.00001

Overview

Application for admittance to JCRS filled out by hand for Samuel Warhaftig and undated. Information on the form includes his age, birth place, occupation, residence, marital status, nearest relatives, and signed by Samuel Warhaftig. The back of the form has sections titled "Report of Medical Advisory Board" and "Report of Executive Committee," both blank. The middle section of the back is a form filled out by hand in ink. It reads, "26, No. 26, 17 [both crossed out], Case #17, Application of, Samuel Warhaftig, Sept. 16/04, Date of Admission April 18 1905, Date of Discharge [crossed out and replaced with] death October 20 1906, Buried 10/20/06, Section 25. Lot 1., Mt. Nebo Cemetery."

Dates

  • between 1904 September 16-1906 October 20

Creator

Rights and Usage Statement

Copyright restrictions may apply. User is responsible for all copyright compliance.

Extent

1 items (application)

Scope and Contents

From the Series: This series of patient records includes medical reports and histories, statistical data of patients, x-rays, and death certificates. The patient files include applications, correspondence and some may also contain photographs and personal items.

Physical Characteristics and Technical Requirements

Fair 30 x 22 centimeter

General

reformatted digital
Title supplied by archivist.

Inscription and Marks

Handwritten in the top right corner of the front page: "Received 9-16-04." Handwritten in bottom left corner of front page: "Admitted 4/18/05." Handwritten in the bottom right corner of the front of the page: "Left town."

Repository Details

Part of the Special Collections and Archives Repository

Contact:
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(303) 871-3428