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what-is-your-name: Philip Scott

what-is-your-age-years: 22

what-is-your-occupation: farmer

where-is-your-residence: Madison

where-were-you-born: Madison

are-you-married: no

what-was-your-wife-s-name-before-marriage:

are-you-married-to-more-than-one-woman:

have-you-children: no

do-your-wife-and-children-enjoy-good-health:

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:

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:

dated: Dec. 18 1924

signed: Philip Scott

witnessed:

witnessed: