8@"0nly the children of one pair of parents to be recorded below; for half-brothers and sisters ask for another blank schedule. 

 8®"In the case of married women, add husband's surname [in brackets], 



CHILD NO. I. 



Full name 2. Date of birth 



Birthplace: Town State or Country 



Education, kind Favorite studies 



Residences, principal 



If married, to whom Date Place 



Occupations at successive ages ..— 



Lesser diseases to which 

 there was special liability: In youth In middle age.. 



9. Grave illnesses in youth in middle age.. 



ID. Operations undergone 



11. If dead, cause of death and age at death 



12. Special tastes, gifts or peculiarities of mind or body. Character, favorite pursuits, etc.. 



CHILD NO. 2. 



I. Full name 2. Date of birth 



3. Birthplace: Town State or Country 



4. Education, kind Favorite studies 



5. Residences, principal 



6. If married, to whom Date Place.. 



7. Occupations at successive ages 



8. Lesser diseases to which 



there was special liability: In youth ..In middle age. 



9. Grave illnesses in youth in middle age 



10. Operations undergone 



11. If dead, cause of death and age at death 



12. Special tastes, gifts or peculiarities of mind or body. Character, favorite pursuits, etc 



