SS-5: Mary Lee Stewart Smith; Bossier & Bienville Parishes, La. Submitted by: Kelly Priestly **************************************************************************** ************************************************ Copyright. All rights reserved. http://usgwarchives.net/copyright.htm http://usgwarchives.net/la/lafiles.htm ************************************************ **************************** Application For Social Security And Tax Account Number (Or Replacement of Lost Card) Information Furnished On This Form Is CONFIDENTIAL 437-64-6974 1. Full Name You Use In Work Or Business (First Middle Last) MRS. MARY S. SMITH 2. Full Name Given You At Birth: MARY LEE STEWART 3. Date Of Birth: SEPT 17, 1903 4. Place Of Birth: SPARTA, BIENVILLE, LA 5. Age At Last Birthday: 57 6. Sex: Male/Female FEMALE 7. Color Or Race: White/Negro/Other WHITE 8. Mother's Full Name At Her Birth: ALPHA JOSEPHINE MOON 9. Father's Full Name, Regardless Of Whether Living Or Dead: ROBERT LEE STEWART 10. Have You Ever Before Applied For Or Had A Social Security Or Railroad Retirement Number? NO If Your Answer Is "YES," Print The State In Which You First Applied And When: ----- Print Your Account Number If You Know It: ----- 11. Are You Now Employed/Self-Employed/Unemployed: EMPLOYED SELF-EMPLOYED 12. Mailing Address: P. O. BOX 57, HAUGHTON, LA 13. Today's Date: JULY 7, 1961 14. Sign Your Name As You Usually Write It: MRS. MARY S. SMITH TREASURY DEPARTMENT INTERNAL REVENUE SERVICE FORM SS-5 (REVISED 3/59) Return completed application to nearest SOCIAL SECURITY ADMINISTRATION DISTRICT OFFICE. --