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Blank No. 24 Series II. Form B 3.

V- Your Maternal Grandfather: home in city or _country_?
1- Age when married? 22
2- Occupations? [Gunsmith?]
3- Health? Fair
4- Number of children? 6 (b). Number reaching maturity? 6

VI- Your maternal grandmother: home in _city_ or country?
1- Age when married? 18
2-Occupations?
3- Health? Dyspeptic
4- Age and cause of death? 84; Pneumonia

VII- Your husband: Nationality, if American, of what descent? Swiss, German
1- Date of birth? Aug. 30,1862
2- Early life in city or _country_?
3-Height? 6 ft
4- Weight? 145 lbs
5- _Muscular_ or weak?
6- Wher educated? Degrees if any? [Indiana University, America?]
7- If a college man, has he been athletic? Baseball to some extent
8- Complexion? Dark
9- Temperament? ([not nervous?] to any great degree)
10- Does he use tobacco? No!
11- Occupations? Farm life, Teacher, [Indefatigable?] worker
12- Health? Good with care; has to husband his strength. [Gripper?], special causes.
13- Diseases in his family: Nervous disorders? Rheumatism? Consumption? Dyspepsia? Varicose Veins? Heart Disease? Hernia? Habitual Constipation? Catarrh?