Given Name:   
Surname:   

Name:  
Civil War:   
Relationship:   
Race:   
Sex:   
Age:   
Marr Status:   
Md In Year:   
Number Children Number Living:   
Birth Place:   
Father Birth Place:   
Mother Birth Place:   
Years In US:   
Naturalized:   
Papers:   
Occupation:   
Mo Unemployed:   
School:   
Read:   
Write:   
Language:   
Disease:   
Defect:   
Prisoner Etc:   
Supp Schedule:   
Owned:   
Free Mortgaged:   
Own Farm:   
Farm Free Mortgaged:   
PO Address: