Permanent Address: Hendersonville, Tenn

Age: 28

Date of Birth: March 8, 1888

U. S. Citizen: a Natural Born Citizen

Where were you born: 6 Dis., Sumner Co., Tenn

What is your present occupation: Farmer

By Whom Employed: My Self

Where employed: 6 Dis., Sumner Co., 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: C R Rice

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

Remarks: No

Date of Registration: June 5, 1917