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WAR HISTORY COMMISSION

STATE OF VIRGINIA

MILITARY SERVICE RECORD

Name in full

(family name): Jackson

(first name): Henry

(middle name): Wirt

Date of birth

(month): March

(day): 6th

(year): 1886

Place of Birth

(town): Keswick

(county): Albemarle

(state): Virginia

(country): U.S.A.

Name of father: Henry Wirt Jackson

Birthplace (country): Va USA

Maiden name of mother: Ellen Randolph Goodman

Birthplace (country): VA USA

Are you White, Colored, Indian or Mongolian: White

Citizen (Yes or no): Yes

Voter (yes or no): Yes

Church (denomination): Episcopal

Married: no

year:

at:

To (maiden name):

Born:

year:

at:

Children

(name):

Born:

year:

at:

Children

(name):

Born:

year:

at:

Children

(name):

Born:

year:

at:

Fraternal Orders:

College Fraternities: Nu Sigma Nu

Previous military service or training: None

Education

(Preparatory):

(College):

Education

(University):

(Degrees):

Occupation before entry into service: Physician

employer:

Residence before entry into the service

(street number): 624 W 141 St

(town): N.Y. City

(county): N.Y.

Present home address

(street number): 777 Madison Ave.

(town): New York

(county): N.Y.

(state): N.Y.