| No. | 68 |
| Name in Full | Charles William Broadbent |
| Age, in yrs. | 23 |
| Home Address | 12, East Dirisiru? St chicago, Illinois |
| Date of Birth | May 23rd 1894 |
| Citizenship | Natural born citizen |
| Where were you born | Chicago, Illinois |
| If not a citizen | ; |
| What is your present trade, occupation, or office | Cerk in wholesale grocery |
| By whom employed | Durand & Casper Company |
| Where employed | Cor. Lake & Union Street Chicago |
| Dependents | Non solely but wife & mother partially |
| Married or single | Married |
| Race | Caucasian |
| What military service have you had | None |
| Do you claim exemption from draft | Yes - ?/s bad Eye sight |
I affirm that I have verified above answers and that they are true
Charlee William Broadbent (Signature or mark)
| Tall, medium or short | Medium |
| Slender, medium or stout | Slender |
| Color of eyes | Dark Blue |
| Color of hair | Light Chesnut |
| Bald | |
| Has person lost arm, leg, hand, foot, or both eyes, or is he otherwise disabled? | No |
E.V. Co???? (Signature of registrar)
Precinct 22 - Ward 21 City or County Chicago State Illinois
Date of registration June 5-1917
Source: Registration State: Illinois
Source: Ancestry - U.S., World War I Draft Registration Cards,
1917-1918