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Blank No.29 Series II Form B. 3.

V. Your Maternal Grandfather: home in city or country?
1- Age when married?
2- Occuaptions?
3- Health?
4- Number of children? b)Number reaching maturity?

VI. Your maternal grandmother: home in city or country?
1- Age when married?
2- Occupations?
3- Health?
4- Age and cause of death?

VII. Your husband: Nationality, if American, of what descent? American
1- Date of birth? 1891
2- Early life in city or country? City
3- Height? 5ft 6 or 7 in
4- Weight? 150
5- Muscular or weak? Not athletic, but [strong?]
6- Where educated? [Stanford?]
8- Complexion? Medium
9- Temperament? Nervous
10- Does he use tobacco? No
11- Occupations? Office
12- Health? Good
13- Diseases in his family: Nervous disorders? Rheumatism? Consumption? Dyspepsia? Varicose Veins? Heart Disease? Hernia? Habitual Constipation? Catarrh?