Permanent Address: Hendersonville, Tenn
Age: 29
Date of Birth: Feb 11, 1888
U. S. Citizen: Natural Born
Where were you born: Mound Hill, Illinois
What is your present occupation: Fishing & Dig Shells
By Whom Employed: Self
Where employed: Henderson, Tenn
Have you a father, mother, wife, child under 12, or a sister or brother under 12, solely dependent
upon you: Wife & 2 children
Married or /Single: Married
Race: Caucasian
Signature: J. T. Graham
Registrar's Report
Remarks: Blank
Date of Registration: June 5, 1917
Tall, Medium or Short: Med
Build: Slender
Color of Eyes: Brown
Color of Hair: Dk. Black
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