177

Blank No. 21 21 Series II. Form B. 1.

Your Father: 1 - Nationality, if American[underlined], of what descent? Irish & English
2 - Home in [deleted]city or[deleted] country before marriage? Plantation
3 - Home in [deleted]city or[deleted] country after marriage? small town in west
4 - Age when married? About 23
5 - Occupations before your birth? farmer
b) after your birth? came to California, no occupation
but trading[?]
6 - Health previous to your birth? good
b) after your birth? well except dispesia
7 - Number of children [deleted]living[deleted] [??]; a) boys? [deleted]7[deleted] 1 b) girls [deleted]4[deleted] 2
8 - Number of children dead; give age at time of death and cause.
a) boys. b) girls. a) 1 b) 2 died from 1-3 years of age
1st wife's child & first child & only.
9 - If your father is living, give his age and present health,
if dead, age at death and cause? in California at 40
fever.
10 - Name any diseases in his famly. dispepsia

Your Paternal Grandfather: home in [deleted]city or[deleted] country? Plantation
1 - Age when married?
2 - Occupations?
3 - Health? good

-329-