Permanent Address: R. D. No 3, Goodlettsville, Tenn

Age: 18

Date of Birth: August 30, 1890

U. S. Citizen: Natural Born Citizin

Where were you born: Brockport, Pennsylvania

What is your present occupation: Stenographer

By Whom Employed: with Agency of W. R. Grace & Co

Where employed: Havana, Cuba

Have you a father, mother, wife, child under 12, or a sister or brother under 12, solely dependent upon you: child age 5 months. Wife partly

Married or /Single: Married

Race: White

Signature: W. A. Alden

Registrar's Report
Tall, Medium or Short: Tall
Build: Med
Color of Eyes: Blue
Color of Hair: light brown

Remarks: Blank

Date of Registration: April 24, 1918