Form SS-5 TREASURY DEPARTMENT INTERNAL REVENUE SERVICE U. S. SOCIAL SECURITY ACT APPLICATION FOR ACCOUNT NUMBER 248-03-5217 Belton 1. (EMPLOYEES FIRST NAME) Ford (MIDDLE NAME) Jenkins (LAST NAME) . . . . . R. F. D. 5 2. (STREET AND NUMBER) Anderson 3. (POST OFFICE) S. C. (STATE) Harper Motor Co. 4. (BUSINESS NAME OF PRESENT EMPLOYER) Anderson S. C. 5. (BUSINESS ADDRESS OF PRESENT EMPLOYER) 52 6. (AGE AT LAST BIRTHDAY) May 27 1884 7. (DATE OF BIRTH) . . . Leesburg, Fla. 8. (PLACE OF BIRTH) Elihu Beauregard Jenkins 9. (FATHER'S FULL NAME) Ida Aleatha Stansell 10. (MOTHER'S FULL NAME) 11. SEX [MALE] 12. COLOR [WHITE] . . . . . 12/3/36 15. (DATE SIGNED) [SIGNED] 16. (EMPLOYEE'S SIGNATURE AS USUALLY WRITTEN)