Permanent Address: R3, Hendersonville, Sumner, Tenn.

Age: 45

Date of Birth: Dec 5, 1872

Race: White

U. S. Citizen: Natural Born

Present Occupation: Wagoner

Employer's Name: S. C: __? & _?W. Dorris

Place of Employment or Address: R3, Hendersonville, Sumner, Tenn

Nearest Relative: Mary Bloodworth

I affirm that have verified above answers and that they are true:
William Jackson Bloodworth

Registrar's Report
Height: Tall
Build: Slender
Color of Eyes: Blue
Color of Hair: Lt. Brown

Remarks: Blank

Date of Registration: Sept 12, 1918