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Blank No 11. Series II. Form B. 1-
Date
I. Your Father: 1 - Nationality, if American, of what descent? American of Eng. descent
From New Eng. colonists.
2 - Home in city or country before marriage? Country & college town
3 - Home in city or country after marriage? City.
4 - Age when married? 25 yrs. 7 mos.
5 - Occupations before your birth?
Teacher & school Supt.
b) After your birth?
Teacher & " "
6 - Health previous to your birth?
good

b)- After your birth?
good, except from brain overwork for
2 yrs.
7 - Number of children living a) boys? 1 b) girls 4
8 - Number of children dead; give age at time of death and cause.
a) boys. b) girls. All living.

9 - If your father is living, give his age and present health,
if dead, age at death and cause?
Living, aged 69 yrs - 4 mos.
10 - Name any diseases in his family.
No special diseases, unless a bilious Tendency,
with occasionally an apparently heart complication.
Your Paternal Grandfather: home in city or country? Country.
1 - Age when married? 27 yrs.
2 - Occupations? Farmer - pioneer in west New York.
3 - Health? Better than average. Iron constitution.

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Blank No 11. Series II. Form B. 1-
Date
I. Your Father: 1 - Nationality, if American, of what descent? American of Eng. descent
From New Eng. [colonists?]
2 - Home in city or country before marriage? Country & college town
3 - Home in city or country after marriage? City.
4 - Age when married? 25 yrs. 7 mos.
5 - Occupation before your birth?
Tracker & school [?]
b) After your birth?
Tracker & " "
6 - Health previous to your birth?
good

b)- After your birth?
good, except from brain [overwork?] for 2 yrs.
7 - Number of children living a) boys? 1 b) girls 4
8 - Number of children dead; give age at time of death and cause.
a) boys. b) girls. All living.

9 - If your father is living, give his age and present health,
if dead, age at death and cause?
Living, aged 69 yrs - 4 mos.
10 - Name any diseases in his family.
No [special?] diseases, [?] a [bilions?] Tendency,
with occasionally an apparently heart complication.
Your Paternal Grandfather: home in city or country? Country.
1 - Age when married? 27 yrs.
2 - Occupations? Farmer - pioneer in west New York.
3 - Health? Better than average. Iron constitution.

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