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Blank No. 29 Series II. Form B. 1.
Date: Mar. 29, 1920. T23

I. Your Father:1- Nationality, if American, of what descent? American- Scotch, Irish, Dutch
2- Home in the city or country before marriage? Country
3- Home in city or country after marriage? City
4- Age when married? 32 years
5- Occupations before your birth? Physician
(b) After your birth?

Son of Middle [Birder?] by [Hamlieu Garland?]. Describes her father's life. Youngest son of 15 children.

6- Health previous to your birth? Good
(b) After your birth? Good

7- Number of children living; a)boys? 1 b)girls 1
8- Number of children dead; give age at time of death and cause.
a)boys b)girls
[No?]

9- If your father is living, give his age and present health; if dead, age at death and cause?
10- Name any diseases in his family.

II. Your Paternal Grandfather: home in city or country?
1- Age when married?
2- Occupations?
3- Health?