Permanent Address: R1, Fountain Head, Sumner, Tenn

Age: 35

Date of birth: Oct 4, 1882

Race: White

U. S. Citizen: Native Born

Present Occupation: Farming

Employer's Name: Self

Place of Employment: R.1, Fountain Head, Sumner, Tenn.

Nearest Relative: Bettie Deasy, R.1, Fountain Head, Sumner, Tenn

Description of Registrant:
Height- Tall
Build- Medium
Color of Eyes- Black
Color of Hair- Black

Date of Registration: Sept. 12, 1918