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Blank No. 11 Series II. Form B. 3.

Your Maternal Grandfather: home in city or country? Small town. Later in city.
1 - age when married? 24 yrs.
2 - occupations? Teaching. Later engaged in business.
3 - health? Fair health, but subject to attacks of pleurisy,
or taking cold.
4 - number of children? 2 b) number reaching maturity? Only one.

Your maternal grandmother: home in city or country? Small towns. Later in city.
1 - age when married? 26.
2 - occupations? Taught before marriage.
3 - health? Not very good. Dyspepsic troubles, principally.
4 - age and cause of death?
Died when nearly ninety-two. Cause, old age
and exhaustion of digestive powers.

Your husband: nationality, if American, of what descent? American - English.
(Descent from Pilgrim Father[?] &
Salem witches).
1 - date of birth? June 29, 1864.
2 - early life in city or country? City.
3 - height? 5 ft. 10 1/2 in.
4 - weight? 208 lbs.
5 - muscular or weak? Unusually muscular. Interested in athletics.
6 - where educated? degrees if any? Public schools & High School of
Syracuse, N.Y.
7 - if a college man, has he been athletic? Not a college man.
8 - complexion? Light -complexioned, tho not extreme.
9 - temperament? Sanguine.
10 - does he use tobacco? Never has.
11 - occupations? Manager of manufacturing business.
12 - health? Very robust, with magnificent frame -
and constitution, as are all the men of his
famly. Early diptheria left him with enlarged tonsils,
which are very suseptible to colds.
13 - diseases in his famly: Nervous Disorers? Rheumatism?
consumption? Dyspepsia? Varicose veins? Heart Disease?
Hernia? Habitual Constipation? Catarrh? No special
disese, unless possible a lttle bronchial
trouble. No inherited disease.

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