3

WAR RECORD

First went into action (place):

(date): July 28th 1918

Participated in the following engagements: Defence of Centea Sector Haute Alsace

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): :

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

Nature of casualty:

(place):

(date):

Nature of casualty:

(place):

(date):

Nature of casualty:

(place):

(date):

Under medical care:-

Name of hospital: Mesnes Fulsey

Location: Mesves

From (date): Oct. 4, 1918

to (date): Nov. 2, 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): Newport News

on (ship): Matsouiq

Date: May 20, 1918

(from): St. Nazaire

Discharged from service at (place): Camp Lee VA

(date): May 27, 1919

as a (rank): Pvt, 1 cl

RETURN TO CIVIL LIFE

Occupation after the war:

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::