Permanent Address: Fountain Head, Tenn

Age: 26

Date of Birth: Oct 11, 1891

U. S. Citizen: a Natural Born Citizen

Where were you born: Allen Co., Ky, USA

What is your present occupation: Making ____ ___

By Whom Employed: Geo W. Ventress

Where employed: near Fountain Head

Have you a father, mother, wife, child under 12, or a sister or brother under 12, solely dependent upon you: Wife and 2 children

Married or /Single: Married

Race: White

Signature: Goodson A. Cole
his
X
Mark

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

Remarks: No

Date of Registration: June 5, 1917