Seial number 2181 Order number 848
Jefferson JACKSON
age - 45
d.o.b. - Aug 8, 1873
permanent home addresss - Philomont, Loudoun VA
Negro (race indicated by a check mark)
Present occupation Farm laborer
Empoyer's name - H.G. Anderson
palce of employment - Philomont Loudoun VA
Nearest relative - Lance Shorts, Middleburg VA
X his mark