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Transcription
What is your name?: John A Jackson
What is your age? (years): 38
What is your occupation?: farming
Where is your residence?: Wolftown
Where were you born?: Graves mill
Are you married?: yes
What was your wife's name before marriage?: [Fannie?] Dade
Are you married to more than one woman?: no
Have you children?: 3
Do your wife and children enjoy good health?: yes
Are you sound in body?: yes
Are you subject to any periodic complaint which is liable to render you unable to follow your usual employment, or which is calculated to shorten life, and thereby render yourself, wife, and children a burden to this Lodge?:
Will you faithfully obey the laws and submit to all the penalties that may be imposed, should it ever be proved that you have made a false statement?:
Dated: June 20, 1925
Signed : John Jackson X
Witnessed: :
Witnessed:
Notes and Questions
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