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To ....Registrar. I apply to register in ... precinct (or ward) of ... County (or City), Virginia. (1) My name is Jessie Fremont Easton Townsend

(2) My age is 59 years. 

(3) I was born at Covington, Kentucky on the 2nd day of July 1861. (4) My residence is Elizabeth Park and has been for the last two years. (5) My occupation is house-maker and has been for the last two years. (6) I have never voted. Signed Jessie E. Townsend