1. Street, avenue, road, etc.

2. House number (in cities or towns)

3. Number of dwelling house in order of visitation

4. Number of family in order of visitation

Name

5. Name of each person whose place of abode on April 1, 1930, was in this family.

Relation

6. Relationship of this person to the head of the family.

Home Data

7. Home owned or rented.

8. Value of home, if owned, or monthly rental, if rented.

9. Radio set.

10. Does this family live on a farm?

Personal Description

11. Sex.

12. Color or race [White (W), Negro (Neg), Mexican (Mex), Indian (In), Chinese (Ch), Japanese (Jp), Filipino (Fil), Hindu (Hin), Korean (Kor), other races spelled out in full.]

13. Age at last birthday.

14. Marital condition. [Single (S), married (M), widowed (Wd), divorced (D).]

15. Age at first marriage.

Education

16. Attended school or college any time since Sept. 1, 1929.

17. Whether able to read and write.

Place of birth

18. Place of birth--PERSON.

19. Place of birth--FATHER.

20. Place of birth--MOTHER.

Mother Tongue (or Native Language) of Foreign Born

21. Language spoken in home before coming to the United States.

Citizenship, etc.

22. Year of immigration to the United States.

23. Naturalization.

24. Whether able to speak English.

Occupation & Industry

25. Trade, profession, or particular kind of work done, as spinner, salesman, riveter, teacher, etc.

26. Industry or business, as cotton mill, dry-goods store, shipyard, public school, etc.

27. Class of worker.

Employment

28. Whether actually at work yesterday (or the last regular working day)--Yes or No

29. If not, line number on Unemployment Schedule.

Veterans

30. Whether a veteran of U.S. military or naval force

31. What war or expedition? [World War (WW), Spanish-American War (Sp), Civil War (Civ), Philippine Insurrection (Phil), Boxer Rebellion (Box), Mexican Expedition (Mex)].