Permanent Address: R3 Gallatin, Sumner, Tenn.

Age: 36

Date of Birth: Mar 13, 1882

Race: White

U. S. Citizen: Natural Born

Present Occupation: Farmer

Employer's Name: Self

Place of Employment or Address: R3 Gallatin, Tenn

Nearest Relative: Mrs. Madge Starks, R3 Gallatin, Tenn

I affirm that have verified above answers and that they are true:
Mills Taylor Bloodworth

Registrar's Report
Height: Medium
Build: Medium
Color of Eyes: Grey
Color of Hair: Dark

Remarks: Blank

Date of Registration: Sept 12, 1918