Document
D.S.S. Form 1 (Revised 6-1-42), c16-21630-3. Registration Card for men born on or after January 1, 1922 and on or before June 30, 1924.
Transcription
| Field | Value |
|---|---|
| Serial Number | N 405 |
| Order Number | 13,636 |
| 1. Name (Print) | GALE (NONE) FULGHUM |
| 2. Place of Residence | 1222 N. Liberty, Independence, Jackson, Missouri |
| 3. Mailing Address | 509 W. Eleventh, Rolla, Phelps, Missouri |
| 4. Telephone | Rolla, 320-J |
| 5. Age in Years | 19 |
| Date of Birth | 2 / 19 / 1923 |
| 6. Place of Birth | Kansas City, N[orth?] (Town or county) / Missouri (State) |
| 7. Person Who Will Always Know Your Address | Mr. Fred F. Fulghum |
| 8. Employer's Name and Address | Missouri School of Mines, Rolla, Mo. |
| 9. Place of Employment or Business | Missouri School of Mines, Rolla, Mo. |
| Registrant's Signature | Gale Fulghum |
Notes
- No middle name: Listed as "(NONE)." Birth name was "Infant Lloyd" per birth certificate File No. 916; later given name "Aura Gale Orrill." By 1942, he used only "Gale Fulghum" with no middle name or initial.
- Residence vs. mailing address: Home address at 1222 N. Liberty, Independence (the Fulghum family home, confirmed by memoir photo captions). Mailing address at Missouri School of Mines in Rolla, where he was a student.
- Contact person: Fred F. Fulghum, his adoptive/stepfather. No address given for Fred, implying same as line 2 (1222 N. Liberty).
- Place of birth: "Kansas City, N" is ambiguous. Could be "North Kansas City" or simply Kansas City with a stray mark. Birth certificate confirms Kansas City, MO (General Hospital).
- Missouri School of Mines: Now Missouri University of Science and Technology (Missouri S&T). Gale studied metallurgical engineering here, consistent with his later career at Westinghouse and International Systems Controls.
- Form date: D.S.S. Form 1 revised 6-1-42 was used for the "third registration" (June 30, 1942) covering men aged 18-20.
Physical Description
Cream-colored card, printed front and back. Handwritten entries in ink. Registrant's signature in cursive at bottom right. Card shows slight aging. Image source: Jordan Fulghum, scanned 2026-03-23.