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December 21st., 1917

[Handwritten] Sample request sent to all Members of Brigade. Returns now being compiled many containing most interesting facts which you may see later.

[Typed] for the purpose of Confidential Brigade Records, please furnish the information asked for below returning it to me as soon as you possibly can. Use both sides of sheet if necessary.

L. D. Supt.
464 Robie St., Halifax, N.S.

Name:
Address:
Nursing Officer's name:
Where were you when explosion Dec. 6th occurred?


Were you injured personally? Were any of your family injured? Was your home destroyed?


Give a narrative of your experience (day by day if necessary) where you worked, what you did, when you helped, nautre of injuries treated, your whole story -

[Handwritten at top of page: MG 1 2124 number 31]