Permanent Address: Goodlettsville, Tenn
Age: 27
Date of Birth: Feb 26, 1890
U. S. Citizen: Natural Born
Where were you born:White Hill, Tenn, U.S.A.
What is your present occupation: Farmer
By Whom Employed: Myself
Where employed: White Hill, Sumner Co., Tenn
Have you a father, mother, wife, child under 12, or a sister or brother under 12, solely dependent
upon you: blank
Married or /Single: Single
Race: Caucasian
Signature: William Bloodworth
Registrar's Report
Remarks: Blank
Date of Registration: June 5, 1917
Tall, Medium or Short: Medium
Build: Medium
Color of Eyes: Light Blue
Color of Hair: Dark
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