Created by us.meta.llama3-2-11b-instruct-v1:0 on 2025-06-13

The image shows a yellowed document with the title "The Commonwealth of Massachusetts" at the top, indicating that it is an application form for state aid under Chapter 179, General Acts of 1917.

• The document has a formal tone and layout, suggesting that it was used for official purposes.
  • The text is written in a serif font, which was common in formal documents during the early 20th century.
  • The layout is organized into sections, with clear headings and spaces for filling in information.
• The document includes several sections, including:
  • A section for the applicant's personal information, such as name, address, and date of birth.
  • A section for the applicant's military service, including the branch of service, rank, and dates of enlistment and discharge.
  • A section for the applicant's family information, including the names and dates of birth of their spouse and children.
  • A section for the applicant's employment history, including their occupation, employer, and dates of employment.
• The document also includes a section for the applicant's signature, indicating that they have read and understood the terms of the application.
  • The signature is located at the bottom of the page, below the section for the applicant's personal information.
  • The signature is accompanied by a statement that the applicant has read and understood the terms of the application.

Overall, the image shows a formal document that was used to apply for state aid in Massachusetts during the early 20th century. The document includes a range of personal and financial information, as well as a section for the applicant's signature.

Created by us.meta.llama3-2-90b-instruct-v1:0 on 2025-06-13

The image depicts a yellowed document with black text, titled "The Commonwealth of Massachusetts" at the top. The document is an application for state aid under Chapter 179, General Acts of 1917, and is addressed to the Mayor and Aldermen or Selectmen of a specific town or city.

The document begins by stating that it is hereby certified that the applicant is a resident of the town or city and has served in the Army, Navy, or United States on the quota of Massachusetts. The applicant's name, age, and enlistment date are requested, as well as their company, regiment, and years of service.

The document also asks for information about the applicant's family, including their spouse's name, age, and death date (if applicable), as well as the names and ages of their children. Additionally, the applicant is asked to declare that they are in necessitous circumstances and are not receiving aid under Chapter 587, Acts of 1914.

At the bottom of the document, there is a section for the applicant to sign and date their application, as well as a note that they must carefully read the notes on the back of the blank before signing. Overall, the document appears to be a formal application for financial assistance from the state of Massachusetts, likely for veterans or their families who are in need of support.

Created by amazon.nova-lite-v1:0 on 2025-06-14

The image shows a document titled "The Commonwealth of Massachusetts" and "Application for State Aid under Chapter 179, General Acts of 1917." The document is a form to be filled out by an individual seeking state aid due to the death of a family member who was in military service. It includes sections for personal information, details of the deceased's service, and the applicant's financial situation. The form also contains a certification statement and a signature line for the applicant. The document is dated 1919 and includes a note to read the instructions on the back before signing.

Created by amazon.nova-pro-v1:0 on 2025-06-14

The image depicts a formal document titled "Application for State Aid under Chapter 179, General Acts of 1917," issued by the Commonwealth of Massachusetts. The document is formatted in a structured manner with specific fields for information entry.

At the top of the document, there is a header that reads "The Commonwealth of Massachusetts," followed by a note indicating that this blank form is not to be used in Civil and Spanish War cases.

The main body of the document consists of a series of blank fields and prompts for the applicant to fill in their personal and service details. The document is divided into several sections:

1. Applicant Information: This section includes fields for the applicant's name, age, enlistment details, and current residence. It also asks for the name of the city or town where the applicant resides and their military service details, including the branch of service (Army or Navy), regiment, and the duration of service.

2. Service Details: This section requires the applicant to provide specifics about their military service, including the date of enlistment, the duration of service, and the circumstances of their discharge. It also asks for the name of the vessel or unit they served on if applicable.

3. Dependent Information: This section is for the applicant to list their dependents, including spouse and children, providing their names, dates of birth, and relationship to the applicant.

4. Financial Information: The document asks whether the applicant is receiving aid from any other sources, such as the United States or any city or town within the state, and requests details about any pension received.

5. Declaration and Oath: The applicant is required to make a sworn declaration affirming the truthfulness of the information provided. This section includes a space for the applicant's signature and the date of signing.

6. Official Certification: There is a section for the official certificate of service to be filed, indicating that the applicant's military service details must be verified and attached to the application.

7. Footer: The document concludes with a footer that reiterates the importance of reading the notes on the back of the blank before signing and includes a signature line for the Justice of the Peace who will witness the oath.

The document is printed on yellow paper, which is typical for official forms from that era, and has a structured layout with clear headings and prompts to guide the applicant in completing the necessary information. The overall design is straightforward, aiming for clarity and ease of use for the applicant.

Created by gemini-2.0-flash on 2025-05-01

Here is a description of the image:

The image is a scan of a historical document titled "The Commonwealth of Massachusetts." It is a form titled "Application for State Aid under Chapter 179, General Acts of 1917."

The form includes sections for filling in information about a person serving in the Army or Navy, including their residence, the city/town they are from, the branch of the military, their enlistment details, and their company and regiment information. There are blanks to fill in dates of enlistment and discharge, and the name of the naval vessel.

There is also a section where a person declares, under oath, their relationship to the service member (wife, widow, mother, father, brother, sister) and that they are deprived of support due to the service member's death or absence. The form requests information about the applicant's children, including their dates of birth.

The form also includes a declaration that the applicant is in necessitous circumstances and not receiving aid from other sources, and an area for the applicant's signature.

The bottom of the document contains a space for an attestation by a Justice of the Peace, confirming that the applicant has made the foregoing statement under oath.

At the very bottom, there are instructions to read the notes on the back before signing.

Created by gemini-2.0-flash-lite on 2025-05-01

The image is of a formal document titled "Application for State Aid under Chapter 179, General Acts of 1917". It is a government form from "The Commonwealth of Massachusetts," designed to be used by individuals seeking financial assistance.

The document is divided into several sections:

• Certification: This section begins with the statement "It is hereby Certified, that..." and provides spaces for information about the individual seeking aid, their military service details (including branch, unit, enlistment information, and service dates), and the reason for applying for aid.
• Oath and Declaration: This section includes an oath where the applicant swears that the provided information is true to the best of their knowledge and identifies their relationship to the servicemember (e.g., wife, widow). It also asks for information about the children of the applicant.
• Declaration of Need: This section declares that the applicant is in need and is not receiving assistance elsewhere. It requests details about pension or financial assistance.
• Signatures and Authentication: The document contains a place for the applicant's signature and date. Below, it provides for the affirmation of an official with the title Justice of the Peace, which ensures the accuracy of the application and confirms the attestation of the information presented.

The document is marked as "This blank not to be used in Civil and Spanish War cases," and also states "Carefully read the notes on the back of this blank before signing."

Created by us.mistral.pixtral-large-2502-v1:0 on 2025-06-14

The image is a historical document titled "Application for State Aid under Chapter 179, General Acts of 1917" from the Commonwealth of Massachusetts. This form is specifically for individuals affected by military service during World War I. Here is a detailed summary of the document:

Header

• Title: The Commonwealth of Massachusetts
• Note: This blank is not to be used in Civil and Spanish War cases.

Main Content

The document is an application for state aid addressed to the Mayor, Aldermen, or Selectmen of a town or city. It certifies the following information about an individual:

1. Personal Information:

   • Name
   • Age at enlistment
   • Residence at the time of enlistment
   • Current residence

2. Military Service Details:

   • Branch of service (Army or Navy)
   • Enlistment date
   • Company, Regiment, and Massachusetts Volunteers (Mass. Vol.)
   • Date and place of mustering into service
   • Duration of service
   • Date and place of honorable discharge
   • For Naval service, the name of the U.S. Vessel and the date of remaining in service until honorable discharge

3. Dependent Information:

   • Name and age of the spouse/widow/mother/father/brother/sister of the serviceman
   • Relationship to the serviceman
   • Marriage date (if applicable)
   • Reason for dependency (death or absence due to service)
   • Names and birthdates of children dependent on the applicant

4. Declaration:

   • The applicant declares under oath that the information provided is true.
   • The applicant states that they are not receiving aid under Chapter 587, Acts of 1914, from any other city or town in the state.
   • The applicant confirms whether they are receiving a pension from the United States and the amount per month.

Signature Section

• Applicant's Signature: To be signed by the applicant.
• Witness Section: To be signed by a Justice of the Peace, confirming that the applicant personally appeared and made the oath.

Footer

• Note: Carefully read the notes on the back of this blank before signing.

This document is a formal application for financial aid for dependents of servicemen who served during World War I, ensuring that they receive the necessary support from the state.