+---------+---+-----------------+--------+--------------+-----------+
| **N     |   |                 |        |              |           |
| ATIONAL |   |                 |        |              |           |
| A       |   |                 |        |              |           |
| RCHIVES |   |                 |        |              |           |
| AND     |   |                 |        |              |           |
| RECORDS |   |                 |        |              |           |
| ADMINIS |   |                 |        |              |           |
| TRATION |   |                 |        |              |           |
| (       |   |                 |        |              |           |
| NARA)** |   |                 |        |              |           |
+---------+---+-----------------+--------+--------------+-----------+
| **MI    |   |                 |        |              |           |
| CROFILM |   |                 |        |              |           |
| RENTAL  |   |                 |        |              |           |
| ORDER   |   |                 |        |              |           |
| FORM**  |   |                 |        |              |           |
+---------+---+-----------------+--------+--------------+-----------+
| **      |   |                 |        |              |           |
| Privacy |   |                 |        |              |           |
| Act and |   |                 |        |              |           |
| Pa      |   |                 |        |              |           |
| perwork |   |                 |        |              |           |
| Re      |   |                 |        |              |           |
| duction |   |                 |        |              |           |
| Act     |   |                 |        |              |           |
| Public  |   |                 |        |              |           |
| Burden  |   |                 |        |              |           |
| sta     |   |                 |        |              |           |
| tements |   |                 |        |              |           |
| are on  |   |                 |        |              |           |
| the     |   |                 |        |              |           |
| back of |   |                 |        |              |           |
| this    |   |                 |        |              |           |
| page.** |   |                 |        |              |           |
+---------+---+-----------------+--------+--------------+-----------+
| **How   |   |                 |        |              |           |
| The     |   |                 |        |              |           |
| Mi      |   |                 |        |              |           |
| crofilm |   |                 |        |              |           |
| Rental  |   |                 |        |              |           |
| Program |   |                 |        |              |           |
| W       |   |                 |        |              |           |
| orks:** |   |                 |        |              |           |
|         |   |                 |        |              |           |
| **      |   |                 |        |              |           |
| General |   |                 |        |              |           |
| Informa |   |                 |        |              |           |
| tion:** |   |                 |        |              |           |
| The     |   |                 |        |              |           |
| Mi      |   |                 |        |              |           |
| crofilm |   |                 |        |              |           |
| Rental  |   |                 |        |              |           |
| Program |   |                 |        |              |           |
| p       |   |                 |        |              |           |
| rovides |   |                 |        |              |           |
| copies  |   |                 |        |              |           |
| of      |   |                 |        |              |           |
| s       |   |                 |        |              |           |
| elected |   |                 |        |              |           |
| N       |   |                 |        |              |           |
| ational |   |                 |        |              |           |
| A       |   |                 |        |              |           |
| rchives |   |                 |        |              |           |
| Mi      |   |                 |        |              |           |
| crofilm |   |                 |        |              |           |
| Publi   |   |                 |        |              |           |
| cations |   |                 |        |              |           |
| for up  |   |                 |        |              |           |
| to 30   |   |                 |        |              |           |
| days at |   |                 |        |              |           |
| a       |   |                 |        |              |           |
| nominal |   |                 |        |              |           |
| fee per |   |                 |        |              |           |
| roll.   |   |                 |        |              |           |
| The     |   |                 |        |              |           |
| mi      |   |                 |        |              |           |
| crofilm |   |                 |        |              |           |
| publi   |   |                 |        |              |           |
| cations |   |                 |        |              |           |
| include |   |                 |        |              |           |
| all of  |   |                 |        |              |           |
| the     |   |                 |        |              |           |
| de      |   |                 |        |              |           |
| cennial |   |                 |        |              |           |
| pop     |   |                 |        |              |           |
| ulation |   |                 |        |              |           |
| census  |   |                 |        |              |           |
| r       |   |                 |        |              |           |
| ecords, |   |                 |        |              |           |
| 179     |   |                 |        |              |           |
| 0-1930, |   |                 |        |              |           |
| and     |   |                 |        |              |           |
| related |   |                 |        |              |           |
| i       |   |                 |        |              |           |
| ndexes, |   |                 |        |              |           |
| and     |   |                 |        |              |           |
| other   |   |                 |        |              |           |
| mi      |   |                 |        |              |           |
| crofilm |   |                 |        |              |           |
| publi   |   |                 |        |              |           |
| cations |   |                 |        |              |           |
| pr      |   |                 |        |              |           |
| imarily |   |                 |        |              |           |
| of      |   |                 |        |              |           |
| i       |   |                 |        |              |           |
| nterest |   |                 |        |              |           |
| to      |   |                 |        |              |           |
| family  |   |                 |        |              |           |
| hist    |   |                 |        |              |           |
| orians. |   |                 |        |              |           |
| You may |   |                 |        |              |           |
| use the |   |                 |        |              |           |
| film    |   |                 |        |              |           |
| for a   |   |                 |        |              |           |
| full 30 |   |                 |        |              |           |
| days,   |   |                 |        |              |           |
| and     |   |                 |        |              |           |
| then    |   |                 |        |              |           |
| return  |   |                 |        |              |           |
| it by   |   |                 |        |              |           |
| mail to |   |                 |        |              |           |
| the     |   |                 |        |              |           |
| address |   |                 |        |              |           |
| below.  |   |                 |        |              |           |
| You may |   |                 |        |              |           |
| keep    |   |                 |        |              |           |
| the     |   |                 |        |              |           |
| film    |   |                 |        |              |           |
| for an  |   |                 |        |              |           |
| add     |   |                 |        |              |           |
| itional |   |                 |        |              |           |
| month   |   |                 |        |              |           |
| [onl    |   |                 |        |              |           |
| y]{.und |   |                 |        |              |           |
| erline} |   |                 |        |              |           |
| by      |   |                 |        |              |           |
| re      |   |                 |        |              |           |
| mitting |   |                 |        |              |           |
| a check |   |                 |        |              |           |
| for     |   |                 |        |              |           |
| \$3.25  |   |                 |        |              |           |
| per     |   |                 |        |              |           |
| roll.   |   |                 |        |              |           |
| We must |   |                 |        |              |           |
| receive |   |                 |        |              |           |
| the     |   |                 |        |              |           |
| check   |   |                 |        |              |           |
| prior   |   |                 |        |              |           |
| to the  |   |                 |        |              |           |
| due     |   |                 |        |              |           |
| date on |   |                 |        |              |           |
| the     |   |                 |        |              |           |
| invoice |   |                 |        |              |           |
| before  |   |                 |        |              |           |
| the     |   |                 |        |              |           |
| ex      |   |                 |        |              |           |
| tension |   |                 |        |              |           |
| can be  |   |                 |        |              |           |
| g       |   |                 |        |              |           |
| ranted. |   |                 |        |              |           |
| Users   |   |                 |        |              |           |
| will be |   |                 |        |              |           |
| charged |   |                 |        |              |           |
| an      |   |                 |        |              |           |
| add     |   |                 |        |              |           |
| itional |   |                 |        |              |           |
| \$3.25  |   |                 |        |              |           |
| per     |   |                 |        |              |           |
| roll    |   |                 |        |              |           |
| for     |   |                 |        |              |           |
| each    |   |                 |        |              |           |
| week    |   |                 |        |              |           |
| the     |   |                 |        |              |           |
| film is |   |                 |        |              |           |
| overdue |   |                 |        |              |           |
| and an  |   |                 |        |              |           |
| \$18.00 |   |                 |        |              |           |
| repl    |   |                 |        |              |           |
| acement |   |                 |        |              |           |
| fee for |   |                 |        |              |           |
| each    |   |                 |        |              |           |
| lost or |   |                 |        |              |           |
| damaged |   |                 |        |              |           |
| film.   |   |                 |        |              |           |
| Any     |   |                 |        |              |           |
| fees    |   |                 |        |              |           |
| for     |   |                 |        |              |           |
| o       |   |                 |        |              |           |
| verdue, |   |                 |        |              |           |
| damaged |   |                 |        |              |           |
| or lost |   |                 |        |              |           |
| film    |   |                 |        |              |           |
| must be |   |                 |        |              |           |
| paid    |   |                 |        |              |           |
| before  |   |                 |        |              |           |
| we send |   |                 |        |              |           |
| add     |   |                 |        |              |           |
| itional |   |                 |        |              |           |
| film to |   |                 |        |              |           |
| a       |   |                 |        |              |           |
| cu      |   |                 |        |              |           |
| stomer. |   |                 |        |              |           |
|         |   |                 |        |              |           |
| **P     |   |                 |        |              |           |
| ayment: |   |                 |        |              |           |
| By      |   |                 |        |              |           |
| check   |   |                 |        |              |           |
| or      |   |                 |        |              |           |
| money   |   |                 |        |              |           |
| order   |   |                 |        |              |           |
| only,   |   |                 |        |              |           |
| payable |   |                 |        |              |           |
| to      |   |                 |        |              |           |
| N       |   |                 |        |              |           |
| ational |   |                 |        |              |           |
| A       |   |                 |        |              |           |
| rchives |   |                 |        |              |           |
| Mi      |   |                 |        |              |           |
| crofilm |   |                 |        |              |           |
| Rental  |   |                 |        |              |           |
| Pro     |   |                 |        |              |           |
| gram.** |   |                 |        |              |           |
| We do   |   |                 |        |              |           |
| not     |   |                 |        |              |           |
| accept  |   |                 |        |              |           |
| payment |   |                 |        |              |           |
| by      |   |                 |        |              |           |
| credit  |   |                 |        |              |           |
| card.   |   |                 |        |              |           |
|         |   |                 |        |              |           |
| **      |   |                 |        |              |           |
| Cost:** |   |                 |        |              |           |
| Rental  |   |                 |        |              |           |
| fees    |   |                 |        |              |           |
| and     |   |                 |        |              |           |
| s       |   |                 |        |              |           |
| hipping |   |                 |        |              |           |
| rates   |   |                 |        |              |           |
| are     |   |                 |        |              |           |
| based   |   |                 |        |              |           |
| on the  |   |                 |        |              |           |
| fo      |   |                 |        |              |           |
| llowing |   |                 |        |              |           |
| volume  |   |                 |        |              |           |
| dis     |   |                 |        |              |           |
| counts: |   |                 |        |              |           |
+---------+---+-----------------+--------+--------------+-----------+
|         | * |                 | **Sh   |              |           |
|         | * |                 | ipping |              |           |
|         | R |                 | Fee    |              |           |
|         | e |                 | per    |              |           |
|         | n |                 | o      |              |           |
|         | t |                 | rder** |              |           |
|         | a |                 |        |              |           |
|         | l |                 |        |              |           |
|         | F |                 |        |              |           |
|         | e |                 |        |              |           |
|         | e |                 |        |              |           |
|         | p |                 |        |              |           |
|         | e |                 |        |              |           |
|         | r |                 |        |              |           |
|         | r |                 |        |              |           |
|         | o |                 |        |              |           |
|         | l |                 |        |              |           |
|         | l |                 |        |              |           |
|         | * |                 |        |              |           |
|         | * |                 |        |              |           |
+---------+---+-----------------+--------+--------------+-----------+
|         | * | > **\$3.50**    | **1-9  | **\$6.00     |           |
|         | * |                 | r      | (USPS)**     |           |
|         | 1 |                 | olls** |              |           |
|         | - |                 |        |              |           |
|         | 4 |                 |        |              |           |
|         | * |                 |        |              |           |
|         | * |                 |        |              |           |
+---------+---+-----------------+--------+--------------+-----------+
|         | * | > **\$3.00      |        |              |           |
|         | * | > (incl. 1-4)** |        |              |           |
|         | 5 |                 |        |              |           |
|         | - |                 |        |              |           |
|         | 9 |                 |        |              |           |
|         | * |                 |        |              |           |
|         | * |                 |        |              |           |
+---------+---+-----------------+--------+--------------+-----------+
|         | * | > **\$2.50      | *      | **\$11.00    |           |
|         | * | > (incl. 1-9)** | *10-25 | (UPS)**      |           |
|         | 1 |                 | r      |              |           |
|         | 0 |                 | olls** |              |           |
|         | - |                 |        |              |           |
|         | 2 |                 |        |              |           |
|         | 5 |                 |        |              |           |
|         | * |                 |        |              |           |
|         | * |                 |        |              |           |
+---------+---+-----------------+--------+--------------+-----------+
|         |   |                 |        |              |           |
+---------+---+-----------------+--------+--------------+-----------+
| **Start |   |                 |        |              |           |
| Up      |   |                 |        |              |           |
| Kit:**  |   |                 |        |              |           |
| We also |   |                 |        |              |           |
| offer a |   |                 |        |              |           |
| Start   |   |                 |        |              |           |
| Up Kit, |   |                 |        |              |           |
| con     |   |                 |        |              |           |
| sisting |   |                 |        |              |           |
| of all  |   |                 |        |              |           |
| of the  |   |                 |        |              |           |
| printed |   |                 |        |              |           |
| census  |   |                 |        |              |           |
| ca      |   |                 |        |              |           |
| talogs, |   |                 |        |              |           |
| the     |   |                 |        |              |           |
| Revolu  |   |                 |        |              |           |
| tionary |   |                 |        |              |           |
| War     |   |                 |        |              |           |
| records |   |                 |        |              |           |
| c       |   |                 |        |              |           |
| atalog, |   |                 |        |              |           |
| and     |   |                 |        |              |           |
| coupons |   |                 |        |              |           |
| for     |   |                 |        |              |           |
| rental  |   |                 |        |              |           |
| of your |   |                 |        |              |           |
| first   |   |                 |        |              |           |
| two     |   |                 |        |              |           |
| rolls,  |   |                 |        |              |           |
| for     |   |                 |        |              |           |
| \       |   |                 |        |              |           |
| $31.00. |   |                 |        |              |           |
| **P     |   |                 |        |              |           |
| urchase |   |                 |        |              |           |
| of the  |   |                 |        |              |           |
| Start   |   |                 |        |              |           |
| Up Kit  |   |                 |        |              |           |
| is      |   |                 |        |              |           |
| [no     |   |                 |        |              |           |
| t]{.und |   |                 |        |              |           |
| erline} |   |                 |        |              |           |
| r       |   |                 |        |              |           |
| equired |   |                 |        |              |           |
| to rent |   |                 |        |              |           |
| microf  |   |                 |        |              |           |
| ilms.** |   |                 |        |              |           |
|         |   |                 |        |              |           |
| **Info  |   |                 |        |              |           |
| rmation |   |                 |        |              |           |
| for     |   |                 |        |              |           |
| Libra   |   |                 |        |              |           |
| ries:** |   |                 |        |              |           |
| Li      |   |                 |        |              |           |
| braries |   |                 |        |              |           |
| rent    |   |                 |        |              |           |
| mi      |   |                 |        |              |           |
| crofilm |   |                 |        |              |           |
| in the  |   |                 |        |              |           |
| same    |   |                 |        |              |           |
| way as  |   |                 |        |              |           |
| indiv   |   |                 |        |              |           |
| iduals, |   |                 |        |              |           |
| except  |   |                 |        |              |           |
| that    |   |                 |        |              |           |
| they    |   |                 |        |              |           |
| have    |   |                 |        |              |           |
| two     |   |                 |        |              |           |
| add     |   |                 |        |              |           |
| itional |   |                 |        |              |           |
| payment |   |                 |        |              |           |
| options |   |                 |        |              |           |
| not     |   |                 |        |              |           |
| av      |   |                 |        |              |           |
| ailable |   |                 |        |              |           |
| to      |   |                 |        |              |           |
| indiv   |   |                 |        |              |           |
| iduals. |   |                 |        |              |           |
| The     |   |                 |        |              |           |
| options |   |                 |        |              |           |
| are (1) |   |                 |        |              |           |
| estab   |   |                 |        |              |           |
| lishing |   |                 |        |              |           |
| a       |   |                 |        |              |           |
| deposit |   |                 |        |              |           |
| account |   |                 |        |              |           |
| (\$50   |   |                 |        |              |           |
| minimum |   |                 |        |              |           |
| to      |   |                 |        |              |           |
| start)  |   |                 |        |              |           |
| or (2)  |   |                 |        |              |           |
| monthly |   |                 |        |              |           |
| billing |   |                 |        |              |           |
| based   |   |                 |        |              |           |
| on      |   |                 |        |              |           |
| usage.  |   |                 |        |              |           |
| To set  |   |                 |        |              |           |
| up a    |   |                 |        |              |           |
| deposit |   |                 |        |              |           |
| account |   |                 |        |              |           |
| or      |   |                 |        |              |           |
| monthly |   |                 |        |              |           |
| billing |   |                 |        |              |           |
| arran   |   |                 |        |              |           |
| gement, |   |                 |        |              |           |
| contact |   |                 |        |              |           |
| our     |   |                 |        |              |           |
| office  |   |                 |        |              |           |
| at      |   |                 |        |              |           |
| (301)   |   |                 |        |              |           |
| 60      |   |                 |        |              |           |
| 4-3699. |   |                 |        |              |           |
+---------+---+-----------------+--------+--------------+-----------+

**Please PRINT the following shipping information:**

  -------------------- ------------ -------------- ----------- --------------
  **NAME**                                                      

  **ADDRESS**                                                   

  **CITY**                                         **STATE**   **ZIP**

  **Daytime Telephone                                           
  Number**                                                     

  **Program Membership                                          
  Number (if known):**                                         
  -------------------- ------------ -------------- ----------- --------------

Place your order by listing the publication (M or T plus number) and
roll number below:

  -- ---------- --------------- -------- -- ---------- --------------- -------- -- ---------- --------------- -------- --
     **Item**   **Publication   **Roll      **Item**   **Publication   **Roll      **Item**   **Publication   **Roll   
                \#**            \#**                   \#**            \#**                   \#**            \#**     

     **1**                                  **10**                                 **19**                              

     **2**                                  **11**                                 **20**                              

     **3**                                  **12**                                 **21**                              

     **4**                                  **13**                                 **22**                              

     **5**                                  **14**                                 **23**                              

     **6**                                  **15**                                 **24**                              

     **7**                                  **16**                                 **25**                              

     **8**                                  **17**                                                                     

     **9**                                  **18**                                                                     
  -- ---------- --------------- -------- -- ---------- --------------- -------- -- ---------- --------------- -------- --

Calculate your total payment:

  ----------------------------------------------------- ----------------------------
  Using the rental fee chart above, calculate the       \$\_\_\_\_\_\_\_\_\_\_\_\_
  rental fee:                                           

  Subtract coupon savings, if applicable (\$3.50 for 1, \-
  \$7.00 for 2):                                        \$\_\_\_\_\_\_\_\_\_\_\_\_

  Using the shipping fee chart above, add the shipping  \+
  fee:                                                  \$\_\_\_\_\_\_\_\_\_\_\_\_

  Add fee for Start Up Kit, if desired (\$31.00):       \+
                                                        \$\_\_\_\_\_\_\_\_\_\_\_\_

  **Total:**                                            \$\_\_\_\_\_\_\_\_\_\_\_\_
  ----------------------------------------------------- ----------------------------

+--------------------------------+-------------------------------------+
| **MAIL THIS FORM AND YOUR      | **National Archives Microfilm       |
| CHECK OR MONEY ORDER TO:**     | Rental Program**                    |
|                                |                                     |
|                                | **P.O. Box 30**                     |
+--------------------------------+-------------------------------------+
|                                | **Annapolis Junction, MD            |
|                                | 20701-0030**                        |
+--------------------------------+-------------------------------------+
|                                |                                     |
+--------------------------------+-------------------------------------+

**Paperwork Reduction Act Privacy Burden Statement**

You are not required to provide the information requested on a form that
is subject to the Paperwork Reduction Act unless the form displays a
valid OMB control number. Public burden reporting for this collection of
information is estimated to be 10 minutes per response. Send comments
regarding the burden estimate or any other aspect of the collection of
information, including suggestions for reducing this burden, to National
Archives and Records Administration (NHP), 8601 Adelphi Road, College
Park, Maryland 20740. DO NOT SEND COMPLETED FORMS TO THIS ADDRESS. SEND
COMPLETED FORMS TO THE ADDRESS INDICATED ON THE FRONT OF THIS FORM.

**Privacy Act Statement**

Sections 2104(a) and 2108 of Title 44 of the U.S. Code authorize the
collection of this information. The primary use of this information is
to process and track your microfilm rental request and to provide
information to you. The information may also be used to facilitate
preparation of statistical and other reports. Furnishing the information
requested on this form is voluntary, but failure to do so will prevent
NARA from processing your microfilm rental request.