Permanent Address: R_?#3, Fountain Head, Tenn
Age: 24
Date of Birth: he doesn't know
U. S. Citizen: a Natural Born Citizen
Where were you born: Jackson County, Tenn
What is your present occupation: Farmer
By Whom Employed: Self
Where employed: near Portland, Tenn
Have you a father, mother, wife, child under 12, or a sister or brother under 12, solely dependent
upon you: Wife and child
Married or /Single: Married
Race: Caucasian
Signature: Arthur Lovell
Registrar's Report
Remarks: Blank
Date of Registration: June _?, 1917
Tall, Medium or Short: Medium
Build: Medium
Color of Eyes: Grey
Color of Hair: Brown
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