This is the official form for all the people at this address. It is quick and easy, and your answers are protected by law. Complete the Census and help your community get what it needs - today and in the future! The Census Bureau estimates that, for the average household, this form will take about 38 minutes to complete, including the time for reviewing the instructions and answers. Comments about the estimate should be directed to the Associate Director for Finance and Administration, Attn: Paperwork Reduction Project 0607-0856, Room 3104, Federal Building 3, Bureau of the Census, Washington, DC 20233. Respondents are not required to respond to any information collection unless it displays a valid approval number from the Office of Management and Budget.

Start Here
Please use a black or blue pen.

1. How many people were living or staying in this house, apartment, or mobile home
on April 1, 2000?

[ ] Number of people

INCLUDE in this number:

• foster children, roomers, or housemates


• people staying here on April 1, 2000 who have no other permanent place to stay


• people living here most of the time while working, even if they have another place to live

DO NOT INCLUDE in this number:

• college students living away while attending college


• people in a correctional facility, nursing home, or mental hospital on April 1, 2000


• Armed Forces personnel living somewhere else


• people who live or stay at another place most of the time

2. Is this house, apartment, or mobile home -Mark [ X] ONE box.

O Owned by you or someone in this household with a mortgage or loan?
O Owned by you or someone in this household free and clear (without a mortgage or loan)?
O Rented for cash rent?
O Occupied without payment of cash rent?

3. Please answer the following questions for each person living in this house, apartment, or mobile home. Start with the name of one of the people living here who owns, is buying, or rents this house, apartment, or mobile home. If there is no such person, start with any adult living or staying here. We will refer to this person as Person 1.

What is this person's name?Print the name below.

Last Name
[ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]

First Name
[ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]

4. What is this person's telephone number?We may contact this person if we don't understand an answer.

Area Code + Number
[ ][ ][ ]-[ ][ ][ ]-[ ][ ][ ][ ]

5. What is this person's sex?Mark [X] ONE box.

O Male
O Female

6. What is this person's age and what is this person's date of birth?

Age on April 1, 2000
[ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]

Print numbers in boxes.
Month Day Year of birth
[ ][ ] [ ][ ] [ ][ ][ ][ ]

NOTE: Please answer BOTH Questions 5 and 6.

7. Is this person Spanish/Hispanic/Latino?Mark [X] the "No" box if not Spanish/Hispanic/Latino.

O No, not Spanish/Hispanic/Latino
O Yes, Mexican, Mexican Am., Chicano
O Yes, Puerto Rican
O Yes, Cuban
O Yes, other Spanish/Hispanic/Latino - Print group.
[ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]
[ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]

8. What is this person's race? Mark [X] one or more races to indicate what this person considers himself/herself to be.

O White
O Black, African Am., or Negro
O American Indian or Alaska Native - Print name of enrolled or principal tribe.
[ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]
[ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]
O Asian Indian
O Chinese
O Filipino
O Japanese
O Korean
O Vietnamese
O Other Asian - Print race.
[ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]
O Native Hawaiian
O Guamanian or Chamorro
O Samoan
O Other Pacific Islander - Print race.
[ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]
O Some other race - Print race.
[ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]

Person 2

1. What is this person's name? Print the name of person 2 from page 2.

Last Name
[ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]
First Name MI
[ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ] [ ]

2. How is this person related to person 1?Mark [X] one box.

O Husband/Wife
O Natural-born son/daughter
O Adopted son/daughter
O Stepson/stepdaughter
O Brother/sister
O Father/mother
O Grandchild
O Parent-in-law
O Son-in-law/daughter-in-law
O Other relative - Print exact relationship
[ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]
If NOT RELATED to Person 1:
O Roomer, boarder
O Housemate, roommate
O Unmarried partner
O Foster child
O Other nonrelative

3. What is this person's sex?Mark [X] ONE box.

O Male
O Female

4. What is this person's age and what is this person's date of birth?

Age on April 1, 2000
[ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]
Print numbers in boxes.
Month Day Year of birth
[ ][ ] [ ][ ] [ ][ ][ ][ ]

NOTE: Please answer BOTH Questions 5 and 6.

5. Is this person Spanish/Hispanic/Latino?Mark [X] the "No" box if not Spanish/Hispanic/Latino.

O No, not Spanish/Hispanic/Latino
O Yes, Mexican, Mexican Am., Chicano
O Yes, Puerto Rican
O Yes, Cuban
O Yes, other Spanish/Hispanic/Latino - Print group.
[ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]
[ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]

6. What is this person's race? Mark [X] one or more races to indicate what this person considers himself/herself to be.

O White
O Black, African Am., or Negro
O American Indian or Alaska Native - Print name of enrolled or principal tribe.
[ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]
[ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]
O Asian Indian
O Chinese
O Filipino
O Japanese
O Korean
O Vietnamese
O Other Asian - Print race.
[ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]
O Native Hawaiian
O Guamanian or Chamorro
O Samoan
O Other Pacific Islander - Print race.
[ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]
O Some other race - Print race.
[ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]
If more people live here, continue with Person 3.
(Note: This repeats for Persons 3 - 6)

Persons 7 - 12

If you didnt have room to list everyone who lives in this house or apartment, please list the others below. You may be contacted by theCensus Bureau for the same information aboutthese people.

Person 7 - Last Name
[ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]
First Name MI
[ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ] [ ]

Person 8 - Last Name
[ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]
First Name MI
[ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ] [ ]

Person 9 - Last Name
[ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]
First Name MI
[ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ] [ ]

Person 10 - Last Name
[ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]
First Name MI
[ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ] [ ]

Person 11 - Last Name
[ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]
First Name MI
[ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ] [ ]

Person 12 - Last Name
[ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]
First Name MI
[ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ] [ ]

The Census Bureau estimates that, for the average household, this form will take about 10 minutes to complete, including the time for reviewing the instructions and answers. Comments about the estimate should be directed to the Associate Director for Finance and Administration, Attn: Paperwork Reduction Project 0607-0856, Room 3104, Federal Building 3, Bureau of the Census, Washington, DC 20233. Respondents are not required to respond to any information collection unless it displays a valid approval number from the Office of Management and Budget.

Thank you for completing your official U.S. Census 2000 form.