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Blank No 10. Series II Form B. 1.
Date April 1894.
I. Your Father: 1 - Nationality, if American, of what descent? American.
2 - Home in city or country before marriage? Small city
3 - Home in city or country after marriage? " "
4 - Age when married? 21 or 22
5 - Occupations before your birth?
Tradesman - was in the Civil War.
b) After your birth? Tradesman and Inventor.

6 - Health previous to your birth? good.

b)- After your birth? good.

7 - Number of children living a) boys? b) girls 1
8 - Number of children dead; give age at time of death and cause.
a) boys. b) girls. 2 Oldest daughter died of
Acute Mania. Aged 24.
Youngest daughter of cholera
infantum or some similar
trouble. Aged 1 year.

9 - If your father is living, give his age and present health,
if dead, age at death and cause?
Age 51 years 6 mos. Present health very good.

10 - Name any diseases in his family.

Your Paternal Grandfather: home in city or country? city
1 - Age when married? Do not know. He was 60 years
old when my father was born.
2 - Occupations? Merchant, I think. Was inventive
3 - Health? Good I think.
[married twice]

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