Permanent Address: Goodlettsville, Tenn
Age: 29
Date of Birth: June 27, 1888
U. S. Citizen: Natural Born
Where were you born: White Hill, Tenn, USA
What is your present occupation: Farmer
By Whom Employed: Myself
Where employed: White Hill, Sumner Co., Tenn
Have you a father, mother, wife, child under 12, or a sister or brother under 12, solely dependent
upon you: Blank
Married or /Single: Single
Race: Caucasian
Signature: His Mark X.
Registrar's Report
Remarks: Rheumatism
Date of Registration: June 5, 1917
James Bloodworth
Tall, Medium or Short: Tall
Build: Slender
Color of Eyes: Dark brown
Color of Hair: Black
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