Ch174.4
American Agencies for War Relief
Civilian Relief
Investigation and Record Blanks
The Cammonmealth af Massarhusetts
The Commonwelth of Massachusetts
Certificate of Reasons for Disbursing State or Military Aid
ENDER CHAITER m CENERAL AUTR OF IN.
Ga to mLLED ES CAREFUAY FOR EVERY AarLCANT
We, the undersigned, oficlals chargel with the dishareement of Milisary and State Aid in the
Date.
City-Towa of
Nane of applios
oertify that we believe, and bave good ressoe to belleve, thst the statements within mode sre trse
Sesa
Age at date
State natere of aolleant's diabitite
If addioted to lleaess, Inloperate ee vieleesy
a.
4. Whai amernt er enth does the saldier on whose aerviee this clalm is lerol allet or etherwise
ppor of a depesdante of any y anthoeised by the 8tale er by the
he soldier ee
the sapoet
t the soldler allow
r asosat to
Does the emalerer
wroca
Stute total emant contribetel veeiy at that time to the applicant by the sobdier
How wach of shis ament wsa Ia parment of woldior's bood or ether ladeloelsesh
Signature
applinant,
What are ths present recuro of the spplist
From labor, bealnes, ete
s
An't of Mor
r alse ad lecalion of
amonst of moeey in bank, i
Amest of peratal property,
of other reacurco, 8
55.
Then persenaly appeared the above-taed oeiale aad applieants, vi
If anolioant sas rat, stabe aacunt selda
ameand
dente?
Ia she ease of the mather, aate whehee s
of his weelkly ines ine
thetm signel, is tra
ael made osth that the abome atatement
10. a the appl a
ter M
ei of he n
ir so, where and when?
ya
Remarksi
OVER
