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Name

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ROOMING HOUSE, INSTITUTION, MILITARY INSTALLATION, BTO.

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This inquiry fo Act of (40 Stat, 91318 U, 6, ©, 901-018) whiok
CONFIDENTIAL 2e{sbrulton Turtstd If tormrded roddanit tetiak ‘he Oennas Fopart casuot

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U, §, DEPARTMENT OF COMMERCE
BUREAU OF THE CENSUS

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Budget Bureau Ne. 41-40964,—-Approval expires December 81, 1950,

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d. B.D, NUMBER - Rane Nodes ee as gaa e pater: |
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42 [FOR HEAD OF HOUSEHOLD | FOR ALL PERSONS FOR PERSONS 14 YEARS OF AGE AND OVER
i ! . NAME RELATIONSHIP RAOR | OBX i yt SWivfa lian 15, or Yosinitem 16 oritem 18), Geseribe Job ce business bold Lagt week ae
| | i LtNo | What ig the name of the hond of thig | Enter relationship of | White (W) How |Iuhe | What State (or stow Nwhag | tte Ot [16906 |ienre Tir wit |e, yor ethene eee en tam 17) Geeeete Lage Job ar buaitgae We
4== household? person to head of | Negro(Neg) old |now country) was he born in? | $4n— | was waa thi, ae fatter |item 16 erie sao EA is POS 2 a
Ie Woes ene the names of all other persons ‘ted _— Indian ee oa ried, Is he a oon | was | Eyon |{TM eee of work was he ! yb kind of business Ke Class of worker eH
thie who live hore? arta wite (1nd) his | wid. | MfBemoutsde Continental United | natu. J Going [2° 477, | this How . |, industry was he working in Be
house List in this order: Bayh Daughter Jopaness | Male | last | owed, aiiceeins oy tecaaas soueare ¥ | pale 7 most of werk a6 pers | he many | For exampla: | For oxampla; 7
3 Ie mt he ‘The howd : Grandson (ep) (M) | birth- | divor- ! ized? Piast = | 2! GOR | didn’t| hours | Natts heals on shoos. ‘8 For PRIVATE (P) gets
House Serial this place His wife i tls Cd : Mother-in-taw Obtuese day? ced, week— week, not look- work Chemists ON ONOAE. ... oo nnscceceevenen \ 100 [MOLLY ......-aeesagenerereonerne or rete al sis aed
(and oni house |o % Unmarried sous aoa dens PR Lodger (Ohi) Fe sepa- Distinguish Oanads- work- counting ing last work F PETE nn cspinsttncpoink — UNILVOTEIEY. ese vena s arenas sane owes tal (@)
apart: | ofdwak | OM @ | three § Married ous and daughters and thoiefsculien Lodge's wite | Wiliping | maale | ‘'ua- | rated, Com Copete-ettee. ing, |WOK | for | week, |last | venn mien Poe eT" | wEPHOUT PAY on fecal
3 essary {og unit poe | ae . Other relatives re ae (Fil) (F) cei or , Nove keeping sreune work? does week? POP. nacenne one mn paannnoees FOri.........0cas00 Red tdhareriasneenane ! anes ov Seininene (NP) y
y:,) nom : Other persons, such as lodgers, aid Otbor 16 batch SAR baddies Snel: At for | house, ho SPOmPON: Meats RR LOTT nee
ranch}? | seroet| 7 | Mend btnd woolivatn and nerve | Fash Pence pig ber Pee Mar PD tired FF 5. | ncoce | Specat | have [Sioaid” | Never wuted-cccinc a |e | i
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available records like the one shown here.

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"FOR ALL AGES

Horrae’. tifer. Free S8/L26
ECSSRPSTELIZD202 « Wtleines turers
THE QUESTIONS BELOW ARE FOR PERSONS LISTED ON SAMPLE LINES
FOR PERSONS 14 OF A 0 *
What |Did he | Has he, {tlcokins| Lat yea, Ineome received by this person in 1048 M focumna Foosived by bialatives n this household | Cask each question)
st atten (Yesin |
highest | thie achool atany item 17)— Last year | Last year, | Last year, how |Last year | Lastyear, |Last year, how | Did he ever corvein
What country were his geade | grade? | time since Hl weeks did (1949), how | how bane } anal Gaaner did | (1949), Re how ex mua waar did | the U. S. Armod Forces
father aud mother born te? of, February let? orn ene much pend => yw he receive, trom Te peepormd mone did: bie relatives | is uring—
nterest, ° is
that hog = work atall, workin ey wae denda, veteran's | tivesin | tives ia ' receive. from ine jay ”
he hae boon | Betcousl: | an employee! in his own ! allowances, pen- this houses | this house-, terest, dividends, itlne,
ne nest aged age gato |, | rar cece aoe naa wou al
80 @ other income . nown {anc 0 l
= (Entes Yours of agp chock a house? | al practice, | (aside from wages oF business, por Roy ether” ver | “e bn ¥ b
LEAVE {Bnter Usercameot | LEAVE | grede— Fer thous 98 years] (Num- | (Number | felore doduor ; Of farm? | earnings)? farses, | Brefeesion- Lnoome (aside vent |4j
BLANK or foreign county) BLANK Saeah poh i anid talon. or ms ; ae aa tone or tate, or farm? earnings)? oie ‘ice. - :
i: oe a <2 |
HITT les nT (1) Yes i [iy Yes (c]Nowe [77] None (] Nome =] None | ([] None "CJ None" Nous NTN ves if) ve cyy%es
i Methe: Ss No ciate cwonay ((Woakar $s enniane *S i rere No |[JNo | [Ne @
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Father: LLSs Yes I ry) [None (] Ne 'K) Noue None [_] None None None Yes Se [] ¥ee ) 1)
Nhe gansiseverns-encenesnaraneee 2 [| No | inAN,
Mother: US ; c \ No 3 wacaay | tired eee LeeRe ee r Lie od 8 1 No KIN? i °
at es None N N None 'f\q None Nong Yes Yes | (59 Yes
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other: Cs CON |v M socr over caaun |THeaSs , : Coe Se, eee e ip jo
[] ¥o0 os [None (CJ None iC] None it] None CJ one ‘LJ one one Yes iCy*e ‘Cy ¥
3 AZ No ri ‘ rr No '[-] Neo i[]No
Vv 30 or over (Weeks) (Weeks) \ ! y y
= oo =o i oS ose
Vi [eae Wooks)_ | (Weeks) " , CJ
cs []None [[] ‘L] Nome [_] None one iL jon — os | [7] Yeo 1 (7) Yea
2 No £2 GV 00 | d | Neo | fSaNo | (gato
dt hacen (Weeks) | (Weeks) | ws ae Dene ‘BAN | age
er ges sae erastine tad i nian | \ did thid | 38. What kind of business or | 35. Class of worke
“ie ot, mente nit 3) To there nay entry tn tows | °O% Sirees dete iio! Choy Wey " industry did he work in? | a g Bes es NP,
oa ee~—Skip to item 36 (2)
aoe eahrine i» (om MSs, 25h, and S50 a ten
tae — catia paroonwea waaried (Mans WOy
1 ara et las Was, or 15 Te mapa taepeme vr genet | Dreonenn
Has this person been married more ea salen ucaecaes — pb ae Sonal iene: children has _ over
than once Sop —How counting stillbirths
C) Yea No years, or [_) Less than 1 yoar —.. Children, or [] None
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