Permanent Address: Mitchellville, Sumner, Tenn.

Age: 29

Date of Birth: Oct 19 1886

U. S. Citizen: Natural Born

Where were you born: Sumner Co., Tenn

What is your present occupation: Farming

By Whom Employed: H. A. Lovell

Where employed: Sumner, Tenn

Have you a father, mother, wife, child under 12, or a sister or brother under 12, solely dependent upon you: No

Married or /Single: Single

Race: Caucasian

Signature: Shell Lovell

Registrar's Report
Tall, Medium or Short: Tall
Build: Slender
Color of Eyes: Blue
Color of Hair: Light

Remarks: Blank

Date of Registration: June 5, 1917