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Blank No. 13 Series II. Form B. 3.

Your Maternal Grandfather: home [deleted]in city[deleted] or country?
1 - age when married?
2 - occupations?
3 - health?
4 - number of children? 8 b) number reaching maturity? 7

Your Maternal grandmother: home in [deleted]city or[deleted] country?
1 - age when married?
2 - occupations?
3 - health?
4 - age and cause of death?

Your husband: nationality, if American[underlined], of what descent?
1 - date of birth? 24 Dec. 185[?]9
2 - early life in [deleted]city or[deleted] country?
3 - height? 5,10
4 - weight? 165
5 - muscular [deleted]or weak?[deleted]
6 - where educated? degrees if any? Colorado University, AB & AM[?]
7 - if a college man, has he been athletic[underlined]? no because he is lame
8 - complexion? dark
9 - temperament? cool, calm & collected
10 - does he use tobacco? never
11 - occupations? teaching at present. Brought up on
a ranch until 17 years old. Thrown from his horse & hip
injured.
12 - health? good. Had Typhoid fever before marriage.
13 - diseases in his family: Nervous Disorders? Rheumatism?[inserted[Mother[inserted]
consumption?[underlined] Dyspepsia? Varicose Veins? Heart Disease?
Hernia? Habitual Constipation[underlined] [inserted]Mother[inserted] Catarrh?

[in left margin]Mother 25 yrs ago [??]
[??] of consumption. [??}
[??] when [??] in Colorado
Father had lung trouble
but did not dies of it[in left margin]

[in right margin]"His mother 25 yrs
ago almost died of
consumption can
[?] no where but in
Colorado. Father
had lung trouble but
did not die
of it."[in right margin]

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