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Blank No. 18 18 Series II. Form B. 1.

Date

I - Your Father: 1 - Nationality, if American, of what descent? American - Remote
ancestors English.
2 - Home in city or country before marriage? country
3 - Home in city or country after marriage? country
4 - Age when married? 23 - first marriage. 36
5 - Occupations before your birth? Farmer
b) after your birth? Farmer
6 - Health previous to your birth? Good
b) after your birth? Good
7 - Number of children living, a)boys [deleted][?][deleted] b) girls
8 - Number of chldren dead; give age at time of death and cause.
a) boys. b) girls.
I am the only child my
father ever had..
9 - If your father is living, give his age and present health,
if dead, age at death and cause? Age 76 - Splendid
health.
10 - Name any diseases in his family. Consumption (Bronchial)

Your Paternal Grandfather: home in city or country? country
1 - Age when married? 18
2 - Occupations? Farmer & teacher
3 - Health? Splendid health

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