serial # 483 order # A 1456
Arthur Garfield JACKSON
Perm. home address - Waterford Loudoun VA
age - 37
d.o.b. March 15th 1881
negro
present occupation - chauffeur
employer's name - E.B. White
place of employment - Leesburg Loudoun VA
Nearest relative - Minnie Ora Jackson
Waterford, Loudoun VA
Arthur Garfield Jackson (signature)