RECOMMENDATION FORM

FORM FOR SPECIAL RELIEF
In duplicate, both copies to be forwarded to the Executive Officer.Issues to be made only to women and children in need; men only when sick and destitute. Following questionsmust be answered in every case.

	CAMP
	DATE	1907
SUPERINTENDENT OF SPECIAL RELIEF,
SIR:
I HAVE RECOMMENDED THAT THE FOLLOWING BE SUPPLIED:
Name of Applicant in full and Age	Wages

Full Name of Parents or Husband or Wife	If not Working, why?

Present Address	Means of Support

Address Prior to April 18th, 1906	Number in Family

Occupation	Relief Already Received from the Rehabilitation Committee

ARTICLES
Approved:	Approved:

Executive Officer	Camp Commander