Permanent Address: Mitchellville, Tenn
Age: 26
Date of Birth: July 24, 1890
U. S. Citizen: Natural Born
Where were you born: Sumner Co., Tenn.
What is your present occupation: Farming
By Whom Employed: Self
Where employed: Sumner Co., Tenn
Have you a father, mother, wife, child under 12, or a sister or brother under 12, solely dependent
upon you: Wife & one child
Married or /Single: Married
Race: Caucasian
Signature: Harvey E. Worley
Registrar's Report
Remarks: Blank
Date of Registration: June 5, 1917
Tall, Medium or Short: Tall
Build: Slender
Color of Eyes: Brown
Color of Hair: Brown
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