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Blank No. 19 Series II. Form B. 2.

(continued) 4 - Number of children? boys 3. girls 2 number reaching maturity? all

Your Paternal Grandmother: home in [deleted]city or[deleted] country? [deleted](dutch descent)[deleted]
1 - age when married? about 20 uncertain
2 - Occupations? [deleted][??] woman[deleted] housewife
3 - health? [deleted]perfect[deleted] good
4 - age and cause of death? about 85 [deleted]Pneumonia[deleted] old age

Your Mother: 1 - Nationality, if American[underlined] of what descent? )Dutch-English)
2 - home in [deleted]city or[deleted] country before marriage?
b) home in [deleted]city or[deleted] country after marriage?
3 - Occupatioins before her marriage? ---- ----
b) after her marriage? housewife
4 - Note any prenatal influences before your birth.
5 - her health previous to your birth? ---- ----
[in margin]tremendous will get better of her some times[in margin]
b - after your birth? always excellent except at change
of life.
6 - Number of miscarriages? Sure she did not.
7 - Her age if living, and present health? [deleted]if not, age at time
of death and cause?[deleted] 87 - almost 88 health
very excellent, has broken hip which
prevents walking but mind and body
perfectly sound.
8 - how was your mother's health affected by the climacteric
(change of life). Not well. Severe attack of billious
colic. age about 50 or more.
9 - name any diseases in her family.
youngest brother died of consumption brought on by exposure & neglect, only member of famly.

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