8 FATHER'S FATHER'S FATHEE 



1. Date of birth. Birthplace and origin. 



2. Occupation. Residences. 



3. Age at ) The place for this entry 



marriage, j is at 4 in next page. 



J r -r \ The place for this entry 



4. do. of wife > ■ , ■ , 



^ J is at 3 in ne.-it page 



5. Mode of life so far as 

 aflfecting growth or health. 



9. Bodily strength and 

 energy, if much above 

 or below the average. 



I o. Keenness or imperfection 

 of sight or other senses. 



1 1 . Mental powers and 

 energy, if much above 

 or below the average. 



1 2. Character and 

 temperament. 



13. Favorite pursuits 

 and interests. 

 Artistic aptitudes. 



14. Minor ailments to [ in youth, 

 which there was ^ 

 special liability ( in middle age. 



r in youth. 

 15. Graver illnesses ■' 



( in middle age. 



16. Cause and date of death, and age at death. 



17. General remarks. 





