Permanent Address: R. R. Gallatin, Tenn

Age: 25

Date of Birth: Sept 23, 1891

U. S. Citizen: Natural Born

Where were you born: Nashville, Tenn

What is your present occupation: Farming

By Whom Employed: Myself

Where employed: Gallatin, Tenn

Have you a father, mother, wife, child under 12, or a sister or brother under 12, solely dependent upon you: None

Married or /Single: Single

Race: Caucasian

Signature: H. B. Cole

Registrar's Report
Tall, Medium or Short: Tall
Build: Stout
Color of Eyes: Gray
Color of Hair: Dk. Brown

Remarks: Blank

Date of Registration: June 5, 1917