Clarke Family - Daniel Wilson Clarke - page 5

 This is a copy of Daniel Wilson Clarke's application for a Social Security Number. It reads:

Form S-4-3                                      U.S. SOCIAL SECURITY ACT

TREASURY DEPARTMENT

INTERNAL REVENUE SERVICE

                                              APLICATION FOR ACCOUNT NUMBER            572-03   0073

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PRINT NAME

           1.  Daniel                      Wilson                      Clarke

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

(MARRIED WOMEN: GIVE MAIDEN FIRST NAME, MARRIED LAST NAME, AND HUSBAND'S LAS NAME.)

        2.  2011 - J. St.             3. Sacramento                    Calif.

            (STREET AND NUMBER)                            (POST OFFICE)                                      (STATE)

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