Permanent Address: blank
Age: 29
Date of Birth: Nov 1888 (note: no day)
U. S. Citizen: Natural Born
Where were you born: Portland, Tenn, U.S.A.
What is your present occupation: Laborer on Farm
By Whom Employed: W. E. ___?
Where employed: Portland
Have you a father, mother, wife, child under 12, or a sister or brother under 12, solely dependent
upon you: blank
Married or /Single: Married
Race: African
Signature: Him Lovell
Registrar's Report
Remarks: The party being registered is a paroled convict.
Date of Registration: June 5, 1917
his
X
mark
Tall, Medium or Short: Tall
Build: Stout
Color of Eyes: Black
Color of Hair: Black
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