Chapter X: Appendix: I

Form suggested by Herr Krohne to be filled up by the police or other agency respecting prisoners for trial.

1. BIRTH.
Place? County? Country?
Date?
Legitimate? or illegitimate?

2. UPBRINGING.
By parents?
By others?
In a public institution?

3. SCHOOLING.
School attendance, regular or not?
Knowledge, Extent of?
Confirmed, or not?
Religious belief?

4. OCCUPATION.
What trade?
Served Apprenticeship, or not?

5. MILITARY TRAINING.
Whether served? and where?

6. IMPRISONMENTS.
How many?
In Local Prisons?
In Penal Servitude?
Other Punishments?

7. PARENTAGE.
Name? Abode? Occupation?
Alive or Dead?
Cause of death? Suicide?
Temperate, or not?
Imprisoned, or not?
Were Parents related?

8. BROTHERS AND SISTERS.
Name? Age? Abode?
Occupation?
How many dead? and of what diseases? Suicide?
Imprisoned, or not?
Temperate, or not?

9. MEANS OF LIVING.
With or Without?
Destitute?
A Pauper?
A Beggar?

10. INDIVIDUAL CHARACTERISTICS.
Character? Temperament?
Mental Capacity?
Habits? Drunken or other?
Indolent?

11. MENTAL AND BODILY STATE.
(_a_) Fits or Convulsions in Childhood, Epilepsy, St. Vitus
Dance, or other nervous diseases?
Insanity? Scrofula? Tuberculosis?
(_b_) Mental and bodily state of near relations same as above?

12. MARRIED.
Maiden name of wife?
Imprisoned?
If Children; How many?
Age, and state of Health?
How many dead?
Of what Disease?
Any imprisoned?
The Home good, or bad?