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. ~~~ASF DO NOT FILL OUT THIS ~3M. <br />This is not an oft,cial census form. It is for informar~onal <br /> <br />IIIII <br />Start Here Please use a <br />. black or blue pen. <br />1. How many people were living or staying in this <br />house, apartment, or mobile home on April 1, 20007 <br />4. What is Person 1's telephone number? We may call <br />this person if we don't understand an answer. <br />Area Code + Number <br />Number of people <br />INCLUDE in this number: <br />• foster children, roomers, or housemates <br />• people staying here on April 1, 2000 who have <br />no other permanent place to stay <br />• people living here most of the time while working, <br />even if they have another place to live <br />DO NOT INCLUDE in this number: <br />• college students living away while attending college <br />• people in a correctional facility, nursing home, or <br />mental hospital on April 1, 2000 <br />• Armed Forces personnel living somewhere else <br />• people who live or stay at another place most <br />of the time <br />2. Is this house, apartment, or mobile home - <br />Mark ©ONE box. <br />^ Owned by you or someone in this household with a _-? <br />mortgage or loant ~ ,%` <br />^ Owned by you or someone in this household free and'~'~' <br />clear (without a mortgage or loan)? ~' '• ~ - <br />~~~ <br />^ Rented for cash rent? ~ ~~'~"'" v <br />^ Occupied without payment of cash rend ,~ `~~ ~~=~- ,> <br />~, .. . <br />~\;~% <br />3. Please answer the following questions for each <br />person living in this house, apartment, or mobile <br />home. Start with the name of one of the people <br />living here who owns, is buying, or rents this <br />house, apartment, or mobile home. If there is no <br />such person, start with any adult living or staying <br />here. We will refer to this person as Person 1. <br />What is this person's name? Print name below. <br />Last Name <br />Frst Name MI <br />5. What is Person 1's sexl Mark ©ONE box. <br />^ Male ^ Female <br />.; ~ ~. <br />6. What is Person 1's age and vs~at is'Person 1's date of birth? <br />Age an April 1, 2000 f "~ <br />~\ ; <br />,-= `'~` <br />;`~, <br />Print numbers in tio~es,; <br />;, <br />Month Day, `~ ,,;;;:Ysar of birth <br />`~ ~ ; t <br />. `` (~~ <br />~ ~~:~` <br />~ NEkTI=:^;~Tease answer BOTH Questions 7 and 8. <br />`\ <br />7. "~,i's;Pe~rson 1 Spanish/Hispanic/Latino? Mark ©the "No" <br />;,,. ''!~ox`tf not Spanish/Hispanic/Latino. <br />~~-'•.\^ No, not Spanish/Hispanic/Latino ^ Yes, Puerto Rican <br />^ Yes, Mexican, Mexican Am., Chicano ^ Yes, Cuban <br />^ Yes, other Spanish/Hispanic/Latino -Print group. ~ <br />8. What is Person 1's race? Mark ©one or more races to <br />indicate what this person considers himself/herself to be. <br />^ White <br />^ Black, African Am., or Negro <br />^ American fndian or Alaska Native -Print name of enrolled or principal tribe. ~ <br />^ Asian Indian ^ Japanese ^ Native Hawaiian <br />^ Chinese ^ Korean ^ Guamanian or Chamorro <br />^ Flipino ^ Vietnamese ^ Samoan <br />^ OtherAsian - Prini race. ~ ^ Other Pacific Islander - Prini race. ~ <br />i <br />^ Some other race - Print race. ~ <br />i' <br />OMB No. 0607-0966: Approval Expires 12I31r1o00 ~ ~ ff more people live here, continue with Person 2. <br />