Vitals/SS-5: Shelby Holemon; Webster Par., Louisiana.
Submitted by: Kelly Priestly
Date: Dec. 2000




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Form SS-5

Treausry Department

Internal Revenue Service

(Revised July 1937)



U. S. Social Security Act

Application For Account Number                    437-16-0339



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





1.  Employee's First Name:                        SHELBY

    Middle Name:                                  (NO MIDDLE NAME)

    Last Name:                                    HOLEMON



2.  Street And Number:                            ROUTE 1



3.  Post Office/State:                            SIBLEY, LOUISIANA



4.  Business Name Of Present Employer:            UNEMPLOYED



5.  Business Address Of Present Employer:         (Blank)



6.  Age At Last Birthday:                         41



7.  Date Of Birth:                                SEPT 27, 1897



8.  Place Of Birth:                               Webster Par., Louisiana



9.  Father's Full Name:                           JOE HOLEMON



10. Mother's Full Maiden Name:                    FANNIE STEWARD



11. Sex:  Male/Female                             MALE



12. Color:  White/Negro/Other                     WHITE



13. Give Date You Became An Employee If You

    Began Employment After Nov 24, 1936:          (Blank)



14. Have You Filled Out A Card Like This Before?      NO



    If Answer is "YES" Enter Place And Date

    Of Original Filing And Reasons For Filing

    Again.



15. Date Signed:                                  OCT 31, 1938



16. Employee's Signature As Usually Written:      SHELBY (HIS X MARK) HOLEMON

    Witnesses:                                    W. R. AKINS, SIBLEY, LA

                                                  LENORA? WATKINS, SIBLEY, LA

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