Date: December 15, 1941
Series: S 900 - Florida State Board of Health Subject files, 1875-1975.
(Page 1 of 1)
Pd 12/12/41 NEW FORM 1
Florida License No. 216
State Board of Health Date Issued 12-15-41
Jacksonville, Florida Class
Application for License to Practice Midwifery
(Chapter 14760, laws of 1931)
To the State Health Officer, Jacksonville:
I, Savannah Brown , residing at No. St.,
in Chaires , Florida, HERBY APPLY FOR A LICENSE TO
PRACTICE MIDWIFERY FOR THE CURRENT CALENDAR YEAR.
My qualifications are as follows:
1. I am An American Race Negro
2. I was 42 years of age on my last birthday: Married - Single - Widow
3. (a) I can speak the English language or languages;
(b) I can read the English language or languages;
(c) I can write the English language or languages;
4. (a) I possess a diploma from the following school for Midwives;
(Give full name and location of institution)
(b) I have attended not less than fifteen (15) cases of labor and newborn
Infants during lying-in periods of less than ten days each, under the instruction of the
Following duly registered and licensed physician or physicians.
(c) I have led extensive unsupervised experience.
5. I am willing to furnish other evidence of my qualifications, if required,
and to submit to an examination as to my ability to practice midwifery.
(Signed) Savannah Brown
Dated Oct. 27 19 41 P.O. Address Chaires Fla