Clarke Family - Daniel Wilson Clarke US Social Security Application for account Number

This is the only record that I could find documenting Daniel Wilson Clarke's birth. This document reads as follows:

Form [unclear]

TREASURY DEPARTMENT                               U.S. SOCIAL SECURITY ACT                    572-03  0073
INTERNAL REVENUE SERVICE           APPLICATION FOR ACCOUNT NUMBER

PRINT NAME

              Daniel                                          Wilson                              Clarke

   (EMPLOYEE'S FIRST NAME}                               (MIDDLE NAME)                              (LAST NAME)

                   2011 J, St,                                                       3. Sacramento                                            Calif.

           (Street and NUMBER)                                          (POST OFFICE)                                      (STATE)

[unreadabel]                                                                                           5. 701- K. St.

BUSINESS NAME OF PRESENT EMPLOYER)  (BUSINESS ADDRESS OF PRESENT EMPLYER)

                     63                                        7. 1874 - FEB - 2 1874                                      8. INDIANA Cambridge City

(AGE AT LAST BIRTHDAY)          (DATE OF BIRTH (MONTH) (DAY) (YEAR)    (SUBJECT TO LATER VERIFICATION)

                                        JOSEPH LANGE CLARKE               10. MARY ELIZ. CORNTHWAIT

                                        (FATHER'S FULL NAME)             (MOTHER'S FULL MAIDEN NAME)

SEX: MALE     FEMALE             12. COLOR; WHITE   NEGRO OTHER

IF REGISTERED WITH THE U.S. EMPLOYMENT SERVICE, GIVE NUMBE OF REGISTRATION CARD   1860

IF YOU HAVE PREVIOUSLY FILLED OUT A CARD LIKE THIS, STATE   no

Apr - 7 1937                 16.                                       D. W. CLARKE

(DATE SIGNED)                                                          (EMPLOYEE'S SIGNATURE AS USUALLY WRITTEN)

                                                                   DETACH ALONG THIS LINE

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