Permanent Address: Hendersonville, Sumner, Tenn.

Age: 18

Date of Birth: May 9, 1900

Race: Negro

U. S. Citizen: Natural Born

Present Occupation: Laborer P___? Plant

Employer's Name: Mason & Han__?

Place of Employment or Address: Edenwold(?), Tenn.

Nearest Relative: Mrs. Anna Bearde, Hendersonville, Tenn.

I affirm that have verified above answers and that they are true:
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Registrar's Report
Height: Medium
Build: Medium
Color of Eyes: Blk
Color of Hair: Black

Remarks: Blank

Date of Registration: Sept 12, 1918