09-21-99 Regular Meeting of La Porte Complete Count Committee

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='` ~r . 7 . '•~hat is Person 2's name? Print name below. M~ Name ~-~ ~ tl First Name MI 2. How is this person related to Person 17 Mark ©ONE box ^ Husband/wife If NOT RELATED to Person 1: ^ Natural-bom soNdaughter ^ Roomer, boarder ^ Adopted son/daughter ^ Housemate, roommate ^ Stepson/stepdaughter ^ Unmarried partner ^ Brother/sister ^ Foster child ^ Father/mother ^ Other nonrelative ^ Grandchild ^ Parent-in-law ^Soh-in-law/daughter-in-law ^ Other relative -Print exact relationship. ~ 3. What is this person's sex? Mark ©ONE box. ^ Male ^ Female 4. What is this person's age and what is this person's date of birth? Print numbers in boxes. Age on April t, 2000- Month Day Year of birth 5. 6. ('E: Please answer BOTH Questions 5 and 6. Is this person Spanish/Hispanic/Latino? Mark ©the `' "No"box if not Spanish/Hispanic/Latino. ~; ;'~:~ ~ ~~ ^ No, not Spanish/Hispanic/Latino ^ Yes, Puerto Rican ~~; ;,. - Yes, Mexican, Mexican Am., Chicano ^ Yes, Cuban ~ ^`, ~;; /'` .~'•, it ^ Yes, other Spanish/Hispanic/Latino- Printgroup. ~ `,!^;,~,`;:- ,,, ~ ; `ti`y ~.> ~, ,~ What is this person's race? Mark ©one or more races to indicate what this person considers himself/herself to be. O white ^ Black, African Am., or Negro ^ American Indian or Alaska Native - Print name of enrolled or principal tribe. ~ ^ Asian Indian ^ Japanese ^ Native Hawaiian ^ Chinese ^ Korean ^ Guamanian or Chamorro ^ Filipino ^ Vietnamese ^ Samoan ^ Other Asian -Print race. ~ ^ Other Pacific Islander - Print race. ~ ^ Some otherrace - Print rata. ~ '~ ni more people live here, continue with Person 3. '; -~ 1. What is Person 3's name? Print name below. ~ 3 Last Name --3s° First Name MI 2. How is this person related to Person 17 Mark ©ONE box. ^ Husband/wife If NOT RELATED to Person 1: ^ Nature!-bom son/daughter ^ Roomer, boarder ^ Adopted son/daughter ^ Housemate, roommate ^ Stepson/stepdaughter ^ B h / i ^ Unmarried partner rot er ster s ^ Foster child ^ Father/mother ^ Other nonrelative ^ Grandchild ^ Parentin-law ti ^ Son-in-aw/daughter-in-law !-`'`~`~ ~~ :; ,~ ^ Other relative -Print `~~'%~ exact relationship. -~ %''" ~' ' i`` ~~~ '' 3. What is this persons Sex~,'~lark ©ONE box. ^ Male O Female-` 4. What is this peison•'s age and what is this person's date of birth? ~~ ~~.~' Print numbers in boxes. Age on Aprif~?. 2t,00~ Month Day Year of birth -~.\..; ~ ~-~ ~L' } ti~,~ v ~~. N(y~TE: Please answer BOTH Questions 5 and 6. >~~ 5:~Is this person Spanish/Hispanic/Latino? Mark ©the "No"box if not Spanish/Hispanic/Latino. ^ No, not Spanish/Hispanic/Latino ^ Yes, Puerto Rican ^ Yes, Mexican, Mexican Am., Chicano ^ Yes, Cuban ^ Yes, other Spanish/Hispanic/Latino -Print group. ~ 6. What is this person's race? Mark ©one or more races to indicate what this person considers himself/herself to be. ^ White ^ Black, African Am., or Negro ^ American Indian or Alaska Native - Prininame of enrolled orprinapal vibe. ~ ^ Asian Indian ^ Japanese ^ Chinese ^ Korean ^ Filipino ^ Vietnamese ^ Other Asian - Print race. ~ ^ Native Hawaiian ^ Guamanian or Chamorro ^ Samoan ^ Other Pacific Islander - Print rata. ~ ^ Some other race - Print race. ~ If more people live here, continue with Person 4.