SOCIAL SECURITY RECORDS

Submitted by Kay Pressley Martynuska

 

U. S. SOCIAL SECURITY ACT

FIRST NAME

        (EMPLOYEE’S FIRST NAME)               (MIDDLE NAME)                               (LAST NAME)

 

         (STREET AND NUMBER)                                  (POST OFFICE)                       (STATE)

 

 (BUSINESS NAME OF PRESENT EMPLOYER)                   (BUSINESS ADDRESS OF PRESENT EMPLOYER)

 

(AGE AT LAST BIRTHDAY)    DATE OF BIRTH: (MONTH)  (DAY)  (YEAR)                 (PLACE OF BIRTH)

 

      (FATHER’S FULL NAME)                                                 (MOTHER’S FULL MAIDEN NAME)

 

SEX:  MALE _X_         FEMALE_____            COLOR: WHITE __X__    NEGRO____  OTHER____

 

IF REGISTERED WITH THE U.S. EMPLOYMENT SERVICE, GIVE NUMBER OF REGISTRATION CARD_________________

 

IF YOU HAVE PREVIOUSLY FILLED OUT A CARD LIKE THIS, STATE ____________________________________________

                                                                                                                                 (PLACE)                                       (DATE)

 

 

____11-26-1936                             _____J. S. Pressley____________________________

(DATE SIGNED)                                                            (EMPLOYEE’S SIGNATURE, AS USUALLY WRITTEN)