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Blank No.26 Series II. Form B. 3.
V. Your maternal Grandfather: home in city or country? Country
1- Age when married? 23
2- Occupations? [Farmer?]
3- Health? Delicate till 55, since very well. Now 95
4- Number of children? 9 (b)Number reaching maturity? 6

VI. Your maternal grandmother: home in city or country? Country
1- Age when married? 22
2- Occupations?
3- Health? Very good
4- Age and cause of death? 86 - Paralysis

VII. Your husband: Nationality, if American, of what descent? English
1- Date of birth? Aug. 1. 1855
2- Early life in city or country? Country
3- Height? 6ft 2in.
4- Weight? 160
5- Muscular or weak? Muscular
6- Where educated? Degrees if any? Dartmouth College, B.A. '76
7- If a college man, has he been athletic? No
8- Complexion? Dark complexion.
9- Temperament? Even
10- Does he use tobacco? No
11- Occupations? Principal of High School
12- Health? Excellent. Died from effect of accident April 2,1888.
13- Diseases in his family: Nervous disorders? Rheumatism? Consumption? Dyspepsia? Varicose Veins? Heart Disease? Hernia? Habitual Constipation? Catarrh?