Permanent Address: Hendersonville, Tenn

Age: 23

Date of Birth: Dec 28, 1894

Where were you born: Warrington, Va

What is your present occupation: Clerk

By Whom Employed: Tenn Chemical Co.

Where employed: Nashville

Have you a father, mother, wife, child under 12, or a sister or brother under 12, solely dependent upon you: No

Married or /Single: Single

Race: Caucasian

Signature: B. F. Cockriell Jr.

Registrar's Report
Tall, Medium or Short: Tall
Build: Slender
Color of Eyes: Brown
Color of Hair: Brown

Remarks: Blank

Date of Registration: June 5, 1917