Part 45, page 40

Transcript

The scan is the source; the transcript is machine-generated from it.

*I CERTIFY that I have carefully examined the applicant and have correctly recorded the results of the examination; and that, to the best of my judgment and belief, he is mentally and physically qualified for service in the Army of the United States. [redacted/crossed out] XXXXXXXXXX Qualified under MR-1-9.

RECOMMEND: †Acceptance for active duty. [crossed out text]

Place 1632nd.SU.Ft.Sheridan,Ill. Signature [illegible] Date 16, December, 1943. Name typed or stamped M.D. Hartman .............. Capt. Medical Corps. (Grade)

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[SPACE BELOW FOR USE OF COMMANDING OFFICER] 1st Ind. MGR SU Ft. Sheridan DEC 1 5 1943 (Headquarters) (Place) (Date)

To: The Adjutant General. The person named above having reported for active duty under proper orders was- †Accepted for active duty ......DEC 1 5 1943...... (Date) [crossed out] Returned to [illegible] status for ........................for the reasons shown above. (Number of months or days) Discharged ...................................... for the reason shown above. (Date) I acknowledge receipt of copy of this report this date. b6 per NPRC b7C [illegible signature] R. E. WORZELLA, 1st Lt. AUS 1632 SU (Date) (Signature of enlisted man) Adjutant.

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NEAREST RELATIVE AND PERSON TO BE NOTIFIED IN CASE OF EMERGENCY

Nearest relative ................................................Alma List........................(Name in full) (Other than wife or minor child) Relationship ..mother.............. Address | (Number and street or rural route; if none, so state) (City, town, or post office) (State or country) Person to be notified in case of emergency ......mother...... (Name in full)

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DESIGNATION OF BENEFICIARY

The persons eligible to be my beneficiary are designated below: 1. ....none.... (Full name of wife; if no wife, or if she is deceased or divorced, so state) 2. ....none.... (Full name and address of each minor child, and each dependent child over 21 years of age. [illegible due to stamp overlay])

In the event of my leaving no widow or child, or their decease before payment is made [partially obscured by stamp] as my beneficiary the relative whose name, relationship, and address are shown below: 3. ....Alma List (mother) same as above....

In the event of the death or disqualification of the last-named dependent relative before payment is made, I then designate as my beneficiary the relative whose name, relationship, and address are shown below: 4. ....John List (father) same as mother's....

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SPECIAL COPY CAUTION: records obtained from records St. Louis, [guess: Missouri] official Corps Centre only [illegible] outside [illegible] ...records are [illegible] personal use or [illegible] to [illegible] or [guess: disseminate] or [guess: Bureau]...

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Signature of enlisted man ......[illegible first name]...... E. ............[illegible]............ [guess: List] (First name) (Middle initial) (Last name) Witnessed at ....FORT SHERIDAN, ILL..... DEC 1 5 1943 19....

[illegible signature] R. E. WORZELLA, 1st Lt. AUS 1632 SU.................. Recruiting Officer. (Signature of witness attesting) (Name of witness typed) (Grade and organization)

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This form will be prepared in duplicate, the original copy signed and forwarded to The Adjutant General and the carbon copy forwarded to the commanding general of the service command. The copy will be clearly marked "Copy" in large block overprint letters diagonally across the face of the form. U. S. GOVERNMENT PRINTING OFFICE 16-18787-2 DB Cooper-4663