Serial # 1130 Order # A 1534
Harvey Garfield JACKSON
Perm. Home Address- Ashburn, Loudoun VA
Age - 41
d.o.b. May 22nd 1877
Negro
Present occupation - Farmwork
Employers name - C.L. Zoll
place of employment - Ashburn, Loudoun VA
Nearest relative - Carrie JACKSON
X his mark