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Application for Adjusted Compensation for Service in Army

Page One of Application for Adjusted Compensation for Service in Army

AAC Form No. 1

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 Secreatry of War or Secretary of the Navy

The following statements are made by me to support my claim for Adjusted Compensation under the provision of the World War Adjusted Compensation Act.

  1. Name of veteran: (Last) Gjenvick (First) Ludvig (Middle) K.
    Service or Serial No. 2100540
  2. Presient address of veteran or dependent:
    (Home number and street) 3530 Newton Ave Minpls
    (City) Minneapolis (County) Hennepin (State) Minn.
  3. Date of birth of veteran (Month) Jan (Day) 11 (Year) 1892
    at (City) Trondhjem (State) Norway
  4. Original entry into World War service in the Army, Navy, Coast Guard, or Marine Corps
    was as a (Rank or Grade) Prvt on (Month) Sept (Day) 20 (Year) 1917
    at Madison Minn
  5. Date of separation (Month) May (Day) 7 (Year) 1919 at Camp Grant Ill
  6. I did have oversea service (did not crossed out)
  7. Service in organization, at stations or on vessels in the order named as follow:
    Co C 351 Inf from 20 of Sept 1917 to Nov 1917
    Co C 346 Inf from Nov 1917 to May 7, 1919
  8. Character given on discharge certificate Excellent
  9. Used by Marine Corps Veterans Only

Page Two of Application for Adjusted Compensation for Service in Army

Item 10 will not be filled out in case of dependent making application

  1. 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 Compensation Act, and designate the following-named person as my beneficiary under the provisions of said act:

    Name (Mr, Mrs or Miss) Mrs. (First) Clara (Middle) S. (Last) Gjenvick

    (Relatinship to beneficiary) wife

    Address of beneficiary (Street number) 3530 (Street) Newton Ave (City) Mipl (County) Henn (State) Minn

    Signature of veteran (First) Ludvig (Middle) K (Last) Gjenvick
  2. (See instructions for this item

Along left boarder of form

FINGERPRINT OF RIGHT HAND OF VETERAN

Page Three of Application for Adjusted Compensation for Service in Army

  1. Commissioned Service (Grades) (From) (To) none
  2. I was a commissioned or warrant officer performing home service not with troups and receiving commutation of quarters or subsistance from___ to ___ and during this period I was on dudy at the following stations: (Station) (From) (To) none
  3. I was granted a farm or industrial furlough from ___ no to ___
  4. I (was not) a conscientious objector who performed no military or naval duties whatever, and (did not) refuse to wear the prescribed uniform of the branch of service in which I was serving.
  5. I (was not) discharged for alienage.
  6. Remarks
  7. I certify that I am the (See Instructions For This Name) Person named in this apllication;

    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 July 8, 1924 Signature of applicant (First) Gjenvick (Middle) Ludvig (Last) K [sic]
  8. Item 20 used when person who served did not fill out the form

Page Four (Numbers 21-25) is used If Dependents Filled out Application (shown below)

Page Four of Application for Adjusted Compensation for Service in Army

 

 

 

 

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