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mother, also her maiden name? Designation and principal titles of yourself, your father, and the father of your mother? Your father and mother, are they respectively English, Welsh, Scotch, Irish, Jewish, or foreign? If foreign, of what country? Wholly or in what degree ? Was either your father or your mother descended from persons persecuted for political or religious opinions, or from political or religious refugees ? If so, state the precise relationship. Mention whether their political or religious opinions became traditional in the family. Occupation of yourself, your father, and the father of your mother ? Specify any interests that have been very actively pursued by them, in addition to their regular occupation or profession.

All the questions in the following paragraph are asked concerning yourself, your father, and your mother respectively:

Date of the birth of ? Place of the birth of (if you do not remember that of either your father or mother, state where he or she resided in early life) ? Mention if it was in a large or small town, a suburb, a village, or a house in the country, To what religious bodies have you (self, father and mother) respectively belonged ? To what political parties? Health at the various periods of life? In early adult life, what was your height (to be estimated, where not accurately remembered) ? Was there anything dis-