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What is your name?: David Reid

What is your age? (years): 22

What is your occupation?: Laborer

Where is your residence?: Madison Co

Where were you born?: " " [Madison Co]

Are you married?: No

What was your wife's name before marriage?: 0

Are you married to more than one woman?: 0

Have you children?: 0

Do your wife and children enjoy good health?: yes

Are you sound in body?:

Are you subject to any periodic complaint which is liable to render you unable to follow your usual employment, or which is calculated to shorten life, and thereby render yourself, wife, and children a burden to this Lodge?: No

Will you faithfully obey the laws and submit to all the penalties that may be imposed, should it ever be proved that you have made a false statement?: I will

Dated: July 6 1883

Signed : David Reid

Witnessed: : Payton Smith

Witnessed: Minor Jackson