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Application form for Harry Glass to JCRS, 1905 December 15

Identifier: B002.01.0097.0097.00001


Application for admittance to JCRS filled out by hand for Harry Glass and dated December 15, 1905. Information on the form includes fields for his age, birth place, occupation, residence, marital status, nearest relatives, not filled out. The back of the form has sections titled "Report of Medical Examiner, blank. The middle section of the back is a form filled out by hand. It reads, "No. 168, Case #89, Application of Harry Glass, Dec. 15, 1905. Admitted December 15,1905. Died Jan. 24, 1906."


  • 1905 December 15


Language of Materials

From the Collection:

The records are primarily in English, but some materials are in other languages, including Hebrew, Yiddish, German, and Russian.

Rights and Usage Statement

This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s).


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 centimeters


Title supplied by archivist.

Repository Details

Part of the Special Collections and Archives Repository

2150 East Evans Avenue
Denver CO 80208
(303) 871-3428