92

What is your name?: Joseph Yearwood

What is your age? (years): [62?] October 11, 1930

What is your occupation?:

Where is your residence?: Criglersville Va.

Where were you born?: [Brightwood Va?]

Are you married?: yes

What was your wife's name before marriage?: Viola Carpnter [Carpenter]

Are you married to more than one woman?: no

Have you children?: no

Do your wife and children enjoy good health?: no

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: Oct 11 = 1930

Signed : Joseph Yearwood

Witnessed: : Edmon Jackson

Witnessed: Robert Camel