Social Security Application

Social Security Application

 

FORM 88-5   
TREASURY DEPARTMENT   
INTERNAL REVENUE SERVICE

U. S. SOCIAL SECURITY ACT APPLICATION FOR ACCOUNT NUMBER 
277-05-5682

PRINT NAME 
1. Vance Eugene Wallace 

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

2. 412 S. Lowry Ave. 

(STREET AND NUMBER)

3. Springfield, Ohio 

(POST OFFICE)   (STATE)

4. The Ainge Tool and Engineering 

(BUSINESS NAME OF PRESENT EMPLOYER)

5. 216 E. High St. 

(BUSINESS ADDRESS OF PRESENT EMPLOYER)

6. 25 

(AGE AT LAST BIRTHDAY)

7. Feb. 23, 1911 

(DATE OF BIRTH)

8. Donnelsville, Ohio 

(PLACE OF BIRTH)

9. Lee D. Wallace 

(FATHER'S FULL NAME)

10. Effie Elizabeth Grube 

(MOTHER'S FULL MAIDEN NAME)

11. SEX: MALE X FEMALE -

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. Nov. 27 - 1936 

(DATE SIGNED)

16. Vance Wallace 
(EMPLOYEE'S SIGNATURE, AS USUALLY WRITTEN)
DETACH ALONG THIS LINE

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

last modified: 98.07.13