Permanent Address: R#2, Portland, Sumner, Tenn

Age: 38

Date of birth: Nov. 27, 1879

Race: White

U. S. Citizen: Native Born

Present Occupation: Farming

Employer's Name: Self

Place of Employment: R#2, Portland, Sumner, Tenn.

Nearest Relative: Nella Payne, R#2, Portland, Sumner, Tenn

Description of Registrant:
Height- Medium
Build- Stout
Color of Eyes- Blue
Color of Hair- Brown

Date of Registration: Sept. 12, 1918