Permanent Address: R-4, Portland, Sumner, Tenn

Age: 34

Date of birth: October 13, 1873

Race: White

U. S. Citizen: Native Born

Present Occupation: Farming and Merchandising

Employer's Name: Self

Place of Employment: R-4, Portland, Sumner, Tenn.

Nearest Relative: Carrie Dye, R-4, Portland, Sumner, Tenn

Description of Registrant:
Height- Medium
Build- Medium
Color of Eyes- Gray
Color of Hair- Light

Date of Registration: Sept. 12, 1918