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

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

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

III - a) Your husband: nationality, if American[underlined], of what descent?
1 - date of birth? Mar. 30, 1858.
2 - early life in city or country? small town
3 - height? Above average
4 - weight? 150
5 - muscular or weak? robust, muscular [??]
6 - Where educated? degrees if any? high school supplementing
at Annapolis.
7 - if a college man, has he been athletic[underlined]? [check-marked]
8 - complexion? fair
9 - temperament? firm. calm
10 - does he use tobacco? no no
11 - occupations? Engineering with tendency to law and abstract
[???]
12 - health? good.
13 - diseases in his family: Nervous Disorders?[check-marked] Rheumatism?
Consumption? Dyspepsia? Varicose veins? Heart Disease?
Hernia? Habitual Constipation? Catarrh?
Cause of death Typhoid fever.

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