Line # |
3. Name4. Color5. Sex6. Age7. Month Born if in Year8. Relationship |
9. S10. M11. W/D12. Married In Year13. Occupation14. Months Unemp.15. Sickness/ Disability |
16. Blind |
17. Deaf/dumb |
18. Idiotic |
19. Insane |
20. Other |
21. School |
22. No Read |
23. No Write |
24. Birthplace25. Father's Birth26. Mother's Birth | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|