aa
Unless these questions are answered fully the application will not be considered. BRITISH HOME AND HOSPITAL FOR INCURABLES.
Offices: 72, CHEAPSIDE, E.C,
THESE QUESTIONS MUST BE ANSWERED FULLY AND RETURNED TO THE SECRETARY,
AndErring of pablosb
£8,10
600 1
1. (a) Name and Age
(b) Residence
tw siïlvo"
2.
Disease
A
*
3.
4.
For
Din voide
5.
Xin his "on
DIA
+
ECT. BIT
AMENTAS MAQɔy nd bents in tam
'...'
I
AsYe Anit
e kett
10 AM!
answered, folly.
Previous occupation and'
income (if married or widow, state husband's occupation)
How supported at present)
time
Whether been in Parish)
Infirmary or Workhouse or received Parish Re- lief
6.
7.
OCCUPATION of Parents' (whether living or dead and INCOME}
Near relatives and their
occupations
Has application been madel to any other Institution,
8.
* TURINČIt emos
9.
Applying for Home or Pension
From
57
Page 60Page 61