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Application of Bennie Black to JCRS, 1907 June 21

Identifier: B002.01.0098.0132.00001


Application for admittance to JCRS filled out by hand for Bennie Black and dated June 21, 1907. Information on the form includes his age, birth place, occupation, residence, marital status, nearest relatives, and signed Bennie Black. The back of the form has sections titled "Report of Medical Examiner" and "Admission and Dismission Committee," are blank. The middle section of the back is a form filled out by hand. It reads, "Application No. 513, Case No. 353, Application of, Bennie Black, Address 1668 Boulevard St., Denver, Colorado, Received June 21 1907, Accepted June 23 1907, Rejected, Admitted July 26 1907, Readmitted, Discharged, Left December 28 1807, Died, Remarks."


  • 1907 June 21


Rights and Usage Statement

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


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 31 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