Application Blank [305]
| No. | | |
|---|
| REHABILITATION COMMITTEE |
|---|
| San Francisco Relief and Red Cross Funds, Inc. |
|---|
| Dated | | | 1907 |
|---|
| Surname | Date | Address | Rooms | Rent |
|---|
| April 17th | | How long? | | | |
| First Name | Age | Occupa-
tion | Earnings Per Week | Physical condition | Name | Address |
|---|
| of Employer |
|---|
| Man | | | | | | | |
| Woman | | | | | | | |
| Children | | | | | | | |
| Others in Family | | | | | Other References |
| Insurance: Amount? | | Savings: Amount? | |
| What companies? | | Real Estate: Value? | |
| Other Property? | |
| Attach two letters of reference. If possible one should be from a former landlord to whom you have paid rent for some time. If you are living in a permanent camp, one letter must be from the Camp Commander. |
| (OVER) |
Above form as illustration
[305] On the reverse side space was provided for answers to the following:
| What sum do you ask from the Rehabilitation Committee? | | | |
| State clearly the use to which you wish to put this money | | | |
| State clearly what have been the circumstances that make this application necessary | |