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************************************************Form SS-5
Treasury Department
Internal Revenue Service
(Revised September 1942)

Application For Social Security Account Number
Required Under Chapter 9, Subchapter A, of the Internal Revenue Code

Read instructions on back before filling in form.

Each item should be filled in.  If the information called for in any item is not known, write "unknown."


1.  First Name:                           HOSEA
    Middle Name:                          ------    
    Last Name:                            McADAMS

2.  Full name under which you work, if different from name 
 shown in item 1                       (Blank)

3.  Present Mailing Address:              Lake Providence
                                          R 1, Box 336, LA

4.  Married Man-Give Wife's Full name
 Before marriage                       Mary Elizabeth McGarity

5.  Business Name of Present Employer     Mrs. Zilla King

6.  Business Address of Present Employe   Lake Providence, 
                                          R1 Box, LA

7.  Age At Last Birthday:                 47

8.  Date Of Birth:                        DEC 11, 1892

9.  Place Of Birth:                       Junction City, Union Ark,LA

10. Father's Full Name Regardless of 
    Whether Living Or Dead:               David Jimerson McAdams

11. Mother's Full Name Before Ever Married,
    Regardless Of Whether Living Or Dead: Betty Elizebeth Drewry

12. Sex:  Male/Female                     MALE

13. Color or Race:  White/Negro/Other     WHITE

14. Have You Ever Filled Out a Card Like
    This before?                          NO

15. Date Signed:                          NOV 28, 1940

16. Applicant's Signature:                Hosea McAdams

Return completed application to, or secure information on how to fill in
application from, nearest Social Security Board Field Office.  
The address can be obtained from local post office.

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