serial # 2142 order # A 50
Webster Burton JACKSON
Perm Home Address - Philomont Loudoun VA
age - 44
d.o.b. - Mar. 11 1874
Negro
Present Occupation - Farm Work
Place of Employemnt - Philomont Loudoun Va
Nearest Relative - Carrie Jackson
Philomont Loudoun Va
Webster Burton Jackson (signature)