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Blank No. 19 Series II. Form B. 3.

Your Maternal Grandfather: home [deleted]in city[deleted] or country?
1 - age when married? [deleted]about 20[deleted] about 25
2 - occupations? [deleted]housewife[deleted] farming & stock raising
[?] [?]
3 - health? [deleted]perfect.[deleted] perfect (suppose)
4 - number of children? 11 b) number reaching maturity? all
6th child was the mother

Your maternal grandmother? home [deleted]in city or[deleted] country? (dutch descent)
1 - age when married? about 20
2 - occupations? housewife
3 - health? perfect
4 - age and cause of death? 70 Pneumonia

VII - Your husband: nationality, if American[underlined], of what descent? Scotch
1 - date of birth? 1826
2 - early life in [deleted]city or[deleted] country?
3 - height? lacks a little of 6 ft. 5:11
4 - weight? 155 for[??] 165 - 170
5 - muscular [deleted]or weak?[deleted]
6 - Where educated? [deleted]degrees if any?[deleted] In Missouri
7 - if a college[underlined] man, has he been athletic? Not college
8 - complexion? neither light nor dark, gray eyes.
9 - temperament? even, happy, sanguine, never depressed.
10 - does he use tobacco? yes.
11 - occupations? everything, beginning in mercantile,
miner (chief) taught, etc at present business man.
12 - health? good, never exuberant, never since
marriage had an illness. Quingy[?] once or twice
13 - diseases in his family: Nervous Disorders? Rheumatism?
Consumption? Dyspepsia? Varicose veins? Heart Disease?
Hernia? Habitual Constipation? Catarrh?[check-marked] Slight
Sisters have palsy
husband " palsy trembling
cancer cause of death of brother called piles
cancer; or something. also bronchial.

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