Description/Transcription
Application For Adjusted Compensation by family of Charles Rudd
(C. Avis Catalog entry #1304)
(Document ID #305)
[Note: this document is unsigned - perhaps a draft or maybe never submitted - ca]
WWC Form No. 1
APPLICATION FOR ADJUSTED COMPENSATION FOR SERVICE IN Army
This application must be sent to the War Department, Navy Department, or Marine Corps, as
indicated in instructions, depending on whether your last service was in the Army, Navy, Coast Guard,
or Marine Corps. Use the envelope provided for this purpose, with the proper address printed on it.
READ INSTRUCTIONS OVER CAREFULLY
To the Secretary of War or Secretary of the Navy.
The following statements are made by me in support of my claim for Adjusted Compensa-
tion under the provisions of the World War Adjusted Compensation Act:
Item
No.
1. Name of veteran:
Rudd Charles Maples Service or Serial No. 1193064
2. Present address of veteran or dependent 916 South 1st
Temple Bell Texas
3. Date of birth of veteran June 20 1895 at Temple Texas
4. Original entry into World War service in the Army, Navy, Coast Guard, or Marine Corps
was as a Private 1st Class on March 9 1918
5. Date of separation November 12 1919 at Killed in aeroplane accident near Stockton California
6. I did (did not) have oversea service.
7. Service in organizations, at stations or on vessels in the order named as follows :
School Military Aeronautics Austin Texas from March 9 1918 to June 4 1918
Rockwell Field S.C.A.S. San Diego, Cal from June 7 1918 to Aug 17 1918
Mather Field, Sacramento, Cal from Aug 17 1918 to Nov [?] 1918
Rockwell Field, San Diego, Cal from Nov 5 1918 to Aug 30 1919
Mather Field, Sacramento, Cal from Aug 30 1919 to Nov 12 1919
8. Character given on discharge certificate
Item 9 will be filled in only by men whose service or part of whose service was in the Marine Corps
9. Embarked for oversea service on -
Item 10 will not be filled out in case of dependent making application Application
10. In accordance with the statements made by me in this application, I hereby apply for the
benefits to which I may be entitled under the provisions of the World War Adjusted Com-
pensation Act, and designate the following-named person as my beneficiary under the pro-
visions of said set:
Name
Address of beneficiary
Signature of veteran
11. Fingerprint of right hand of veteran
12. (See instructions for this item.)
(a) Name: Rudd Chas Maples
(b) Serial No.: Army 1193064
(c) Address: Deceased
(d) Date of Birth: June 20 1895 Temple Texas
(e) Rank and organization: Second Lt. Army Air Service 91st Aero Squadron
13. Commissioned service: GRADES FROM- TO-
2nd Lt Oct 25 1918 Nov 12 1919
14. I was a commissioned or warrant officer performing home service not with troops and receiv-
ing commutation of quarters or of subsistence from _
to _ and during this period I was on duty at the following
stations:
None
15. I was granted a fan or industrial furlough from _ to _
16. I (was not) a conscientious objector who performed no military or naval duties what-
ever, and did (did not) refuse to wear the prescribed uniform of the branch of service in
which I was serving.
17. I (was not) discharged for alienage.
18. Remarks:
19. I certify that I am the Mother named in this application;
that the statements made herein are made by me of my own free act and deed for the
purpose of applying for Adjusted Compensation under the provisions Of the World War
Adjusted Compensation Act; and that the same are true and correct to the best of my
knowledge and belief.
Date
Signature of applicant _
Item 20 will not be filled in when dependent makes application
20. We, the undersigned, certify that we know the person signing the application to be identical
with the veteran whose service is set forth in the above application, that we have known
him (her) for _ years and _ years, respectively;
and that he (she) understands the statements made by him (her) and the penalty provided
by law for making false statements.
Signature of witnesses:
Dependents must be sure to submit with their application the affidavits as shown in the instruc-
tions which are required by law and regulations.
The following items will be completed only when dependent makes application for compensation
21. At the time of his death the veteran named in this application had the following-named
dependent relatives now living :
1. Widow or widower __
2. Child __
3. Mother Maggie Mooring Rudd
4. Father __
22. I am Mother of the veteran named in this application; I was
a dependent of him at the time of his death, at which time I was 50 years
old, and in accordance with the statement made by me in this application I hereby
apply for the benefits to which I may be entitled under the provisions of the World War
Adjusted Compensation Act.
23 My address is 916 South 1st Temple Texas
24. Signature of dependent Maggie Mooring Rudd
25. Fingerprint of dependent
26. Item 26 for dependent only.
STATE OF Texas
COUNTY OF Bell
Subscribed and sworn to before me at
Temple, Bell Co., Texas this ___ day of __
_______ (Signature of individual administering oath)
