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Blank No. 33 Series II Form B. 1.
Date:

I. Your father: 1- Nationality, if American, of what descent? American, Scotch-Irish descent.
2- Home in city or country before marriage? Country and small town.
3- Home in city or country after marriage? Small town
4- Age when married? 19
5- Occupations before your birth? Lumber business which was partially outdoor and partially office work. He was also always a great student.
(b) After your birth? the same

6- Health previous to your birth? Good
(b) After your birth? Good for three or four years.
7- Number of children living; (a)boys? 1 (b)girls 1
8- Number of children dead; give age at time of death and cause.
(a)boys (b)girls. 1 - died at 32; of consumption
9- If your father is living, give his age and present health, if dead, age at death and cause? Dies at age of 41 of cerebral meningitis, brought on by overwork.
10- Name any diseases in his family. There were one or two cases of [consumption?], but I think it would not be called a family disease. There is tendency to nervous troubles.

II. Your Paternal Grandfather: home in city or country? Small town.
1- Age when married? 23
2- Occupations? Merchant and Post Master
3- Health? Good