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Blank No.33 Series II. Form B. 3.
V. Your Maternal Grandfather: home in city or country? Country
1- Age when married? 20 yrs about.
2- Occupations? Farming
3- Health? Good
4- Number of children? 7 or 8 (b)Number reading maturity? 3

VI. Your maternal grandmother: home in city or country? Country
1- Age when married? About 27
2- Occupations? Housekeeping
3- Health? Good
4- Age and cause of death? Died at age of 89 of old age.

VII. Your husband: Nationality, if American, of what descent? American, English and French descent.
1- Date of birth? July 24, 1872
2- Early life in city or country? City till 9 yrs. old then in town not thickly populated.
3- Height? 6ft
4-Weight? 150 lbs
5- Muscular or weak? Medium
6- Where educated? Degrees if any? Stanford '93 A.B., H. '96 L.L.B.
7- If a college man, has he been athletic? No
8- Complexion? Light
9- Temperament? Moderate
10- Does he use tobacco? Or stimulants? No
11- Occupations? teaching
12- Health? Fair
13- Diseases in his family: Nervous Disorders? Rheumatism? Consumption? Dyspepsia? Varicose Veins? Heart Disease? Hernia? Habitual Constipation? Catarrh?
Consumption, Dyspepsia