serial# 633 order # A1600
Charles William JACKSON Jr
RFD 2 Middleburg Loudoun Va
age - 33
d.o.b.- April 20 1888
Negro
occupation - Laborer
employer - J(?) Walter Parkins
near Unison Loudoun Co Va
nearest relative - Mabel L Jackson
RFD Middleburg Loudoun Va
signed Charles William Jackson Jr.