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Blank no. 4 4 Form A.

1. Name in full. arried? Twenty-nine
a) before marriage fair b)after marriage fair

2. Address.

3. Date of birth. October 13 - 1857

4.Place of birth. Windham, Connecticut
Temperment.

5.Where educated; give degrees if any. Occupation before marriage. Give length of time spent in each.
In public & private schools of Conn. Typewriting - one year - Accountant in St. R.R. office about one year. (Baltimore)

6. Nationality of mother. American
([deleted] Dutch [deleted] - English)

7. Nationality of father. American
(Dutch - Irish - English)

8.Age of [deleted]father[deleted] [inserted]mother[inserted] when married? Twenty-three

9 Age of [deleted]mother[deleted] [inserted]father[inserted] when married? Twenty-two

10 general health of parents? Fair

11.Nationality of husband. American
(New England)

12. Date of birth of husband. Jan 26 - 1859

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