CHILD NO. 9- 



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 



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. ID. 



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 



ID. Operations undergone 



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



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



S&^li more children than spaces, please write for a second blank record. 



