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

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..~ :e ,~ Nha+ is Person 4's name7 Print name below. ~ s 4 first Name MI how is this person related to Person 77 Mark ©ONE box. ] Husband/wife If NOT RELATED to Person t: ] Natural-born son/daughter ^ Roomer, boarder ] Adopted son/daughter ^ Housemate, roommate ] Stepson/stepdaughter ^ Unmarried partner ] Brother/sister ^ Foster child ] Father/mother ^ Other nonrelative ] Grandchild ] Parent-in-law ] Son-in-law/daughter-in-law ] Other relative - Pn'nt exact relationship. ~ Yhat is this person's sex? Mark ©ONE box. ] Male ^ Female Yhat is this person's age and what is this person's date .f birthl Print numbers in boxes. >ge on April t, 2000 Month Day Year of birth ?lease answer BOTH Questions 5 and 6. this person Spanish/Hispanic/Latino? Mark ©the '`" 'No"box if not Spanish/Hispanic/Latino. - ` ; ~: ~~^) w' ] No, not Spanish/Hispanic/Latino ^ Yes, Puerto Rican ;•., ~~ :.; `~ ^ Yes, Cuban _. •,~ ]Yes, Mexican, Mexican Am., Chicano '~ ~-~' ~"' ,~, •,, ] Yes, other Spanish/Hispanic/Latino -Print group. ~ ~\ ~, •,~ • =~'~ ---_ , -~ ~~~ Vhat is this person's racer Mark ©one or more races to idicate what this person considers himself/herself to be. ] White ] Black, African Am., or Negro ] American Indian or Alaska Native -Print name of enrolled or principal lobe. ~ ] Asian Indian ^ Japanese ^ Native Hawaiian ] Chinese ^ Korean ^ Guamanian or Chamorro ] Filipino ^ vetnamese ^ Samoan ] Other Asian -Print race. ~ ^ Other Pacific Islander - Pant race. ~ ] Some other race - Print race. ~ n~...e people live here, continue with Person 5. • ~. 1. What is Person 5's name7 Print name below. ~~~~' last Name IL_ First Name MI 2. How is this person related to Person 11 Mark ©ONE box. ^ HusbandMrife If NOT RELATED to Person 1: ^ Natural-bom son/daughter ^ Roomer, boarder ^ Adopted son/daughter ^ Housemate, roommate ^ Stepson/stepdaughter ^ Unmarried partner ^ Brother/sister ^ Foster child ^ Father/mother ^ Other nonrelative ^ Grandchild ~ t ^ Parent~n-law _ ^ Son-in-law/daughter-in-law ,~~~ ~' .. ^ Other relative -Print ; ~ ..'~;•, exact relationship. -;~ •~! ' 3. What is this person's~sax7 Mark ©ONE box. ^ Male ^`'fier+ale 4. What is this parson's age and what is this person's date of birth? ` - '' Print numbers in boxes. Age on ~il;ril ;; 2000 Month ~` Day Year of birth ~~. ~-:~ ;- , ~; ; ~ ~. , ~:.; `.%r 'NOTE: 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 himse/f/herself to be. ^ White ^ Black, African Am., or Negro ^ American Indian or Alaska Native -Print name of enrolled or prinrpal tribe. ~ ^ Asian Indian ^ Japanese ^ Chinese ^ Korean ^ Filipino ^ vetnamese ^ Other Asian - Print race. ~ ^ Native Hawaiian ^ Guamanian or Chamorro ^ Samoan ^ Other Pacific Islander -Print race. ~ ^ Some other race - Print race. ~ '~ If more people live here, corrtinue with Person 6. :~ ioai