Age in years: 21

Home Address: RR3, Goodlettsville, Tenn

Date of birth: May 17, 1897

Where were you born?: Millersville, Tenn, USA

I am A Native of the United States

Father's birthplace: Millersville, Tenn, USA

Name of employer: Self

Place of employment: Millersville, Tenn

Name of nearest relative: J. J. Payne, RR3, Goodlettsville, Tenn

Race: White

Registrar's Report
Medium, Slender
Color of Eyes- Blue
Color of Hair- Brown

Date of Registration: June 5, 1918