Social Security Application

Social Security Application

 

FORM 88-5   
TREASURY DEPARTMENT   
INTERNAL REVENUE SERVICE

U. S. SOCIAL SECURITY ACT APPLICATION FOR ACCOUNT NUMBER 
292-01-2585

PRINT NAME 
1. Miriam Alice Shank 

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

2. RR# 6 

(STREET AND NUMBER)

3. Dayton Ohio 

(POST OFFICE)   (STATE)

4. Delco Products 
Division of General Motors Corporation 

(BUSINESS NAME OF PRESENT EMPLOYER)

5. 329 E. First St. Dayton, Ohio 

(BUSINESS ADDRESS OF PRESENT EMPLOYER)

6. 21 

(AGE AT LAST BIRTHDAY)

7. Oct. 26, 1915 

(DATE OF BIRTH)

8. Dayton, Ohio 

(PLACE OF BIRTH)

9. Charles Shank 

(FATHER'S FULL NAME)

10. Clara Maud Neff 

(MOTHER'S FULL MAIDEN NAME)

11. SEX: MALE - FEMALE X

12. COLOR: WHITE X NEGRO - OTHER -

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

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

(PLACE)   (DATE)

15. Dec. 4, 1936 

(DATE SIGNED)

16. Miriam Alice Shank 
(EMPLOYEE'S SIGNATURE, AS USUALLY WRITTEN)
DETACH ALONG THIS LINE

[RECORDS] [RECORDS BY NAME] [RECORDS BY TYPE]

last modified: 98.07.13