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WAR HISTORY COMMISSION

STATE OF VIRGINIA

MILITARY SERVICE RECORD

Name in full

(family name): Johnson

(first name): Samuel

(middle name): T.

Date of birth

(month): Nov.

(day): 15

(year): 1889

Place of Birth

(town): Derry Station

(county):

(state): Penn

(country):

Name of father:

Birthplace (country):

Maiden name of mother:

Birthplace (country):

Are you White, Colored, Indian or Mongolian:

Citizen (Yes or no):

Voter (yes or no):

Church (denomination):

Married:

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:

Previous military service or training:

Education

(Preparatory): High School

(College):

Education

(University):

(Degrees):

Occupation before entry into service:

employer:

Residence before entry into the service

(street number):

(town):

(county):

Present home address

(street number): 35 Rodgers St.

(town): Bluefield

(county):

(state): W. VA