Permanent Address: 206 N. Water, Gallatin, Sumner, Tenn.

Age: 35

Date of Birth: Dec 25, 1882

Race: White

U. S. Citizen: Natural Born

Present Occupation: _? Photography

Employer's Name: Myself

Place of Employment or Address: Gallatin, Sumner, Tenn

Nearest Relative: P? M? Stark, 206 N. ?, Gallatin, Sumner, Tenn

I affirm that have verified above answers and that they are true:
E. M. Stark

Registrar's Report
Height: Short
Build: Stout
Color of Eyes: Gray
Color of Hair: Dark

Remarks: Blank

Date of Registration: Sept 12, 1918