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Blank No. 16 B Series II. Form B. 3.

Your Maternal Grandfather: home in city or country? small town
1 - age when married? young.
2 - occupations? Minister.
3 - health? Not robust.
4 - Nmber of children? 7 b) number reaching maturity? all

Your maternal grandmother: home in city or country? country
1 - age when married? young
2 - occupations? housewife
3 - health? good.
4 - age and caue of death? Middle age. mourned to death
for husbands.

B-III - Your husband: Nationality, if American[underlined] , of what descent?
1 - date of birth? 1861.
2 - early life in city or country? small town
3 - height?
4 - weight?
5 - muscular or weak? reasonably strong but not muscular.
6 - Where educated? degrees if any? Wisconsin University.
7 - if a college man, has he been athletic? not athletic tho played
base ball
8 - complexion? fair.
9 - temperament? nervous.
10 - does he use tobacco? no. no stimulants.
in printing office.
11 - occupations? Student and teacher, college professor
12 - health? medium. has had bowel trouble.
13 - diseases in his family: Nervous Disorders? Rheumatism?
Consumption? Dyspepsia?[underlined & check-marked] Varicose veins? Heart Disease?
Hernia? Habitual Constipation?[check-marked] Catarrh?[check-marked] Bowel trouble, father
[deleted]Catarrh/mother[deleted]

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