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Application from William Schaffer to JCRS, 1905 December 18

 Item
Identifier: B002.01.0097.0099.00002

Overview

Application for admittance to JCRS filled out by hand for William Schaffer and dated December 18, 1905. Information on the form includes his age, birth place, occupation, residence, marital status, nearest relatives, and signed by William Schaffer. The back of the form has sections titled "Report of Medical Advisory Board," and "Report of Executive Committee," blank. The middle section of the back is a form filled out by hand. It reads, "Application No. 170, Case No. 97, Application of William Schaffer, Dec 20/05. Date of admission December 28, 1905. Left December 29, 1905." Handwritten below, "Left Dec. 29, 1905. Buried in Mount Nebo Cemetery May 27, 1906, Section L, Lot 17.

Dates

  • 1905 December 18

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 28 x 22 centimeters

General

reformatted digital
Title supplied by archivist.

Inscription and Marks

Handwritten at top right, "12-18-05." Stamped in blue at upper right and filled out in blue stamp/handwriting, "Received: Dec 19 1905; Accepted: Dec 27 1905; Admitted: Dec 28 1905; Left: 12-29-05."

Repository Details

Part of the Special Collections and Archives Repository

Contact:
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Denver CO 80208
(303) 871-3428