100

What is your name?: A. M. [Brahham?]

What is your age? (years): 47, 1882 March, 4.

What is your occupation?: Blacksmith

Where is your residence?: Criglersville Va.

Where were you born?: W. F. (Wake Forest?) North Carolina

Are you married?: yes

What was your wife's name before marriage?: Mray [Mary?] Robinson

Are you married to more than one woman?: no

Have you children?: no

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?:

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 : A. M. [Brahham?]

Witnessed: : Edmon Jackson

Witnessed: Robert Camel