Permanent Address: RFD#3, Fountain Head, Tenn

Age: 22

Date of Birth: June 13, 1894

U. S. Citizen: a natural born citizen

Where were you born: Franklin, Ky

What is your present occupation: a farmer and peddler of produce

By Whom Employed: Self

Where employed: near Fountain Head, Tenn

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

Married or /Single: Married

Race: Caucasian

Signature: H. C. Lovell

Registrar's Report
Tall, Medium or Short: Medium
Build: Medium
Color of Eyes: Gray
Color of Hair: dark brown

Remarks: Blank

Date of Registration: June 5, 1917