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GENOGRAM

Family name: Completed by:

Date: Family address:

Salesman Admin. Assistant Real-estate

55

56-10

55

Generation 1 L.E. M.E. B.E.

M(1979) M

D(1992) 2008

Generation 2

28

31

30

23

E.E. T.E. S.E. R.E.

2005

M M

Generation 3

1

4

S.E. H.E.

Key

Male M Married

Female Death

Divorce (D) M Line

Please include cause of death and chronic illness when appropriate.