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No. 9 Series II. Form B. 2.
I (continued) 4 - Number of children? 10 number reaching maturity? 2
I Your Paternal Grandmother: home in city or country? [check mark above country] born
1 - Age when married? about 18
2 - Occupations? housewife & farm work
3 - health? Always good
4 - Age and cause of death? 74 or 5

I - Your Mother: 1 - Nationality, if American of what descent? Am. NewEngland ( A [?] )
2 - home in city or country before marriage? [checkmark above country]
b) home in city or country after marriage? [checkmark above country]
3 - Occupations before her marriage? housework.
b) After her marriage? "
4 - Note any prenatal influences before your birth.
5 - her health previous to your birth? good as far as known.
b - after your birth? good until she was 50 had heart trouble
and rheumatism helpless for 9 yrs (when children were small had [c?] on mouth. then had acne in face.
6 - Number of miscarriages? --
7 - Her age if living and present health? if not, age at time
of death and cause? 64. Rheumatic pleurisy.
8 - how was your mother's health affected by the climacteric
(change of life). heart & [rheumations?] as change of life

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her father

9 - Name any disease in her family. Mother had rheumations
her father died [?]. One sister dropped dead of heart disease. Sister had "