102

Blank No 12. Series II Form B. 1.
Date
I. Your Father: 1 - Nationality, if American, of what descent? English and Scotch-Irish.
2 - Home in city or country before marriage? Country
3 - Home in city or country after marriage? Small city; lived[?] in country.
4 - Age when married? 25 yrs. 7 mos.
5 - Occupation before your birth? Teaching and studying

b) After your birth? Teaching and school superintendence

6 - Health previous to your birth? Excellent.

b)- After your birth? Excellent.

7 - Number of children living a) boys? One b) girls. Four
8 - Number of children dead; give age at time of death and cause.
a) boys. b) girls. a. None b. None.

9 - If your father is living, give his age and present health,
if dead, age at death and cause? My father is living
at 68. hale and hearty
10 - Name any diseases in his family. Disposition to biliousness;
and heart weakness? No diseases.
Your Paternal Grandfather: home in city or country? Country.
1 - Age when married? 26 yrs. 11 mos.
2 - Occupations? Farming
3 - Health? Sound; died of pneumonia at 87 yrs. 8 1/2 mos.
- 185 -
cidu.
9 - Name any diseases in her family. None. -187-