Permanent Address: Mitchellville
Age: 28
Date of Birth: March 18, 1889
U. S. Citizen: Natural Born
Where were you born: Robertson Co, Tenn
What is your present occupation: Section hand
By Whom Employed: L & N Railroad
Where employed: Mitchellville, Tenn
Have you a father, mother, wife, child under 12, or a sister or brother under 12, solely dependent
upon you: Wife and one child
Married or /Single: Married
Race: African
Signature: James A. West
Registrar's Report
Remarks: Blank
Date of Registration: June 5, 1917
his
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Mark
Tall, Medium or Short: Med
Build: Stout
Color of Eyes: Dark
Color of Hair: Black
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