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mfa3qw at Apr 21, 2020 07:19 PM

46

What is your name?: Mr. G Gray

What is your age? (years): 40

What is your occupation?: Farmer

Where is your residence?: Madison C H Va

Where were you born?: " CO "

Are you married?: yes

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

Are you married to more than one woman?: no

Have you children?: yes

Do your wife and children enjoy good health?: yes

Are you sound in body?: [yes?]

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 10th 1880

Signed : W S [Gray?]

Witnessed: : Miner Jackson

Witnessed: M H Weaver

46

What is your name?: Mr. G Gray

What is your age? (years): 40

What is your occupation?: Farmer

Where is your residence?: Madison C H Va

Where were you born?: " CO"

Are you married?: yes

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

Are you married to more than one woman?: no

Have you children?: yes

Do your wife and children enjoy good health?: yes

Are you sound in body?: [yes?]

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 10th 1880

Signed : W S [Gray?]

Witnessed: : Miner Jackson

Witnessed: M H Weaver