Age—57.
Occupation—Real estate dealer (retired).
Residence—Unfixed, changed frequently (last, Hickwood, two days, boarding).
Family—No immediate family (no one nearer than nephews and nieces).
Rating in Bradbury's—No rating.
Insured in any other companies—No.
Insured with us for what amount—Twenty thousand dollars.
Name of beneficiary—Charles Scott.
Residence—Hickwood, New York (village).
Occupation—Inventor.