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Application from Beckie Moses to JCRS, 1905 December 21

 Item
Identifier: B002.01.0097.0101.00003

Overview

Application for admittance to JCRS filled out by hand for Beckie Moses and dated December 21, 1905. Information on the form includes her age, birth place, occupation, residence, marital status, nearest relatives, and signed in Russian. 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. 173, Case No. 102, Application of Beckie Moses, Dec 21/05. Date of admission January 17, 1906. Date of Death, May 9, 1906." Handwritten below, "Buried in Mount Nebo Cemetery May 10/06 Sec. L, Lot 50."

Dates

  • 1905 December 21

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.

Repository Details

Part of the Special Collections and Archives Repository

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