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Blank No. 18 Series II. Form B. 3.

Your Maternal Grandfather: home in city or country? country
1 - age when married?
2 - occupations? Farmer
3 - health? good
4 - Number of children [deleted]five[deleted] [inserted]six[inserted] b.) number reaching maturity? five.

Your maternal grandmother: home in city or country? country
1 - age when married?
2 - occupations?
3 - health? good
4 - age and cause of death? Fell from a horse and
died of internal injuries at the age of 37 or 38

VII - Your husband: nationality, if American, of what descent? American
1 - date of birth? 1848
2 - early life in city or country? city some but mostly
country.
3 - height? 5 ft. 8 1/2
4 - weight? 160
5 - muscular or weak? very muscular
6 - Where educated: degrees if any? District school
Academy at Fulton NY
Cornell - BS.
7 - if a college man, has he been athletic? strong but not
athletic
8 - complexion? medium
9 - temperament? Nervous - melancholy in tendency
10 - does he use tobacco? During the last five years
has smoked a very little.
once a day - perhaps
11 - occupations? Professor in [??]
12 - health? - Subject to nervous break fowns -
unless cared for very attentively
13 - diseases in his family: Nervous Disorders? Rheumatism? yes.
Consumption? Dyspepsia? Varicose veins? Heart Disease?
Hernia? Habitual Constipation? Catarrh?

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