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Name (Print clearly) (Last name) McVey (First name) Lawrence (Middle name in full [[blank]]
Address  (Number) 256 (Street) West 128 (City or town) New York, (State) N.Y.

I hereby apply for disability allowance under the provisions of Section 200 of the World War Veterans' Act, 1924, as amended July 3, 1930, and submit the following facts as evidence that I am eligible for that allowance. 

1. (a) Place of birth Flatonia, Texas
   (b) Date of birth  May 11, 1897
2. Description of applicant as of date of this application:
  Sex  Male  Race  colored  Weight  150  pounds.  Height 5ft-11 inches.
  Color or hair  brown  Color of eyes  Brown  Complexion  Brown
3. Make a cross (x) after branches of service you served in: 
   Army (X), Navy [[blank]], Marine Corps [[blank]], Coast Guard [[blank]]
4. Give dates of enlistment and discharge for each period or periods of service during the World War, commencing prior to November 11, 1918.

[[seven column table]]
|Enlisted Date|Enlisted Place|Serial No.|Discharged Date|Discharged Place|Rank and organization|Character of discharge|
|10/26/17|New York, N.Y.|103499|2/24/19|Camp Upton, N.Y.|Corp. Co. D. 369th Inf.|Good|
[[/seven column table]]

Note.— If during any of these enlistments you served under a name other than the one used in this application, state the name under which you served, the period of enlistment, and full explanation.

5. (a)Have you ever applied for disability compensation?  Yes
   (b) When and where?  New York, N.Y.
   (c) What is your Compensation Claim number? [[blank]]
   (d) Have you ever been physically examined for the United States Veterans Bureau?  Yes
   give date and place of last examination  Hospital #81  130 Kingsbridge Rd
   Bronx, New York.
6. (a) Are you in receipt of retirement pay?  No
   (b) Are you in receipt of reduced retirement pay?  No
   (c) Are you in receipt of retainer pay?  No
   (d) Are you in receipt of a pension?  No
   (e) Are you in receipt of disability compensation?  No
   (f) Are you in receipt of insurance benefits?  No

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7. Nature of disease or injury on account of which disability allowance is claimedNature of disease or injury on account of which disability allowance is claimed
Gunshot wound in left arm, chronic rheumatic pains

8. Give full name and complete address of nearest relative
Mr. Wiliam McVey (Father) Flatonia, Texas

9. Have you ever been dishonorably discharged from any period of service in any branch of the military or naval service:  No  If answer is "Yes" state rank and organization at time of dishonorable discharge, and the date of the dishonorable discharge  [[blank]]

10. (a) Are you employed?  No  (b) What is your regular trade or vocation:  Waiter-chauffer
[[blank line]]

11. (a) Did you file a Federal incomeo. tax return for the last year?  No.
    (b) Where? [[blank]]
    (c) Were you exempted from payment of an income tax?  Yes
    (d) If so, why?  [[blank]]

  I HEREBY CERTIFY  that all answers to all questions are true and complete to the best of my knowledge and belief. (Note sections of law printed on reverse side of form.)

(Signature of claimant)  [[blank]]

SUBSCRIBEF AND SWORN to before me this [[blank]] day of [[blank]], 193 [[blank]], by [[blank]] claimant, to whom the statements herein were fully made known and explained.

  Notary Public [[blank]]
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(SEAL)