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What is your name?: Robert Hill

What is your age? (years): 28 1923 September 22

What is your occupation?: [Labercy?] [Laborer]

Where is your residence?: Criglersville. Va

Where were you born?: Criglersville

Are you married?: no

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

Are you married to more than one woman?: not at all.

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?: yes

Dated: Oct. 10. 1931

Signed : Robert Hill

Witnessed: : Edmon Jackson

Witnessed: Robert Camel