Form No. 107, prepared by the Provost Marshal General.

Certificate of Discharge because Physically Deficient

To all whom it may concern:

        This certifies that the person named herein was called for the military service of the United States by his Local Board, and reported at this camp and was physically examined on the 22nd day of May, 1918, by Navy E. S. Bullock M. R. C., and the said Medical Officer having found that Louis West, Elkader, Iowa, whose Serial Number......was physically deficient and not physically qualified for military service; he is therefore hereby discharged from liability to serve under the present call for military service of the United States made by his Local Board.

       This  certificate  is issued subject to all the limitations and conditions of the Act of Congress approved May 18, 1917, and of all the Rules and Regulations prescribes there under, amongst which are:

       1 - It shall not continue when a cause therefore no longer exists.

       2- It may at any time be revoked, withdrawn, or modified by his local Board, so as to render such person liable for military service or it may be renewed.

      3- The person to whom it is issued shall immediately report in person and shall notify his board of ---

           (a) The discontinuance of the cause for the issuance of this certificate, or

           (b) Any change which might modify in any way the cause of his discharge.

      4- Upon receiving notice that this certificate has been revoked, withdrawn, modified, or renewed, the person to whom it is issued shall at once present it in person to his Local Board and surrender it.

      5- A failure to report in person or to give notice as herein required, or conform to any of the conditions hereof will be sufficient ground for the immediate revocation and withdrawal of this certificate.

     6- This certificate may be affirmed, modified, or withdrawn in accordance with the decision of Local Board having jurisdiction. 

E. S. Bullock, Major, M. R. C.

(Signature of first examining physician)

_______________________________

(Signature of second examining physician)

Dated 28 day of May, 1918.

Filed May 16th, 1919, at 10:30 o'clock a. m.                 Freda Katschkowsky        County Recorder