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Blank No. 21 Series II. Form B. 3.

Englishman
Your Maternal Grandfather: home [deleted]in city[deleted] or country? On a plantation
in Deleware
1 - age when married? ----
2 - occupations? ---
3 - health? died at 35
[deleted]died at 74 or 5[deleted]
4 - number of children? 10 b.) number reaching maturity? 9
1 died at 8 years.
& raised 3 others

Your maternal grandmother: home in city or country?
1 - age when married? 19 (2 times married 5 by each)
2 - occupations? ---
3 - health? very delicate baby; better later in life, always delicate
4 - age and cause of death? 88[?]

VII - Your husband: nationality, if American[underlined], of what descent? English
1 - date of birth? 1828 Oct.
2 - early life in [deleted]city or[deleted] country?
3 - height? 5.11 in stockings
4 - weight? 165 or 170
5 - muscular [deleted]or weak]deleted?
6 - where educated: degrees if any? N.Y. in an academy
7 - if a college man, has he been athletic? active but not athletic
8 - complexion? brown eyes & brown hair, dark
9 - temperament? nervous, sanguine
10 - does he use tobacco? [deleted]not now[delted] occasionally
11 - occupations? Lawyer, speculatur[?]
12 - health? variable, [deleted]never[deleted] has had hemorages of
lungs as a young man. Liver trouble
13 - diseases in his family: Nervous[check-marked] Disorders? Rheumatism?
weak lungs Consumption? Dyspepsia? Varicose veins? Heart Disease (father [?]
Hernia? Habitual Constipation? Catarrh?
Paralysis, father, father's brother & sister.

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