3

WAR RECORD

First went into action (place): Oct. 12, 1917

(date):

Participated in the following engagements: See ciataion on separate sheet of paper.

Cited, decorated, or otherwise honored for distinguished services (give circumstantial accounts of exploits, including dates and places where performed, also by whom and in what manner the honors were bestowed): : See citation

Killed in action, killed by accident, died of wounds, died of disease, wounded, gassed, shell-shocked, taken prisoner:

Nature of casualty: Wounded

(place): Verdun

(date): May 27, 1918

Nature of casualty:

(place):

(date):

Nature of casualty:

(place):

(date):

Under medical care:-

Name of hospital:

Location: Souilly

From (date): May 27, 1918

to (date): June 5, 1918

Name of hospital:

Location:

From (date):

to (date):

Name of hospital:

Location:

From (date):

to (date):

Name of hospital:

Location:

From (date):

to (date):

Permanently disabled (through loss of limb, eyesight, etc.) (specify disability):

Arrived at (American port): New York

on (ship): Mobile

Date: Apr 23, 1919

(from): Brest.

Discharged from service at (place): Camp Dix

(date): Apr. 27, 1919

as a (rank): Private 1st Class.

RETURN TO CIVIL LIFE

Occupation after the war: Teacher

If a change of occupation was occasioned by reason of disability acquired in the service, describe the process of re-education and readjustment, and indicate the agencies or individuals chiefly instrumental in furnishing the new occupations::