SEC. 4. CHILDREN OR DEPENDENTS (Include partial dependents)
1. NAME: NOT APPLICABLE
RELATIONSHIP:
ADDRESS:
AGE:
2. NAME:
RELATIONSHIP:
ADDRESS:
AGE:
3. NAME:
RELATIONSHIP:
ADDRESS:
AGE:
CITIZENSHIP:

SEC. 5. FATHER (Give the same information for stepfather and/or guardians on a separate sheet)
FULL NAME: JOHN BENJAMIN
LIVING OR DECEASED: LIVING
DATE OF DECEASE:
PRESENT, OR LAST, ADDRESS: 57 ST. PAUL ST., BALTIMORE, MD, USA
DATE OF BIRTH: 21 NOV 1893
PLACE OF BIRTH: CENTREVILLE, MARYLAND, USA
IF BORN OUTSIDE U.S.A. INDICATE DATE AND PLACE OF ENTRY: N/A
CITIZENSHIP: USA
WHEN ACQUIRED: BIRTH
WHERE:
OCCUPATION: AUTO DEALER
NAME EMPLOYER: EAST END AUTO CO., BALTIMORE
EMPLOYER'S OR OWN BUSINESS ADDRESS: PULASKI HWY, BALTIMORE, MD
MILITARY SERVICE FROM: 1915 TO 1919
BRANCH OF SERVICE: ARMY AVIATION
COUNTRY: USA, GT. BRITAIN
DETAILS OF OTHER SERVICES, U.S. OR FOREIGN: NONE

SEC. 6. MOTHER (Give the same information for stepmother on a separate sheet)
FULL NAME: ADRIENNE MADRIQUETTE
LIVING OR DECEASED: DECEASED
DATE OF DECEASE: 5 FEB 1943
CAUSE: CANCER
PRESENT, OR LAST, ADDRESS: MILFORD AV., BALTIMORE, MD, USA
DATE OF BIRTH: 10 AUG 1900
PLACE OF BIRTH: ROMANS, DROME, FRANCE
CITIZENSHIP: USA
WHEN ACQUIRED: 1921 (?)
WHERE: BALTIMORE, MD, USA
IF BORN OUTSIDE U.S.A. INDICATE DATE AND PLACE OF ENTRY: NOV 1919, NEW YORK.