Serial # 1101 order # A2214
Norman Henry JACKSON
perm home address- RFD Middleburg Loudoun Co VA
age - 35
d.o.b. - Nov 19 1882
Negro
Present Occupation - Farm Laborer
Employer's Name - G. B. Gaither(?) Jr.
R D 2 Middleburg VA
Place of Employment - near Unison Loudoun VA
Nearest Relative - Fleecy Jackson
R.D. Middleburg
Norman Henry Jackson (signature)