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15a. Did this person live in this house five years ago (April 1. 1975)?

If In college or A rmed Forces in April 19 75, report place of residence there.

O Born Apnl 1975 or later - Turn to next page for next person

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O Yes, this house - Skip to 16 O No, different house

b. Where did this person live five years ago (April 1. 1975)?

18a. Is this person a veteran of active-duty military service in the Armed Forces of the United States?

If service was In National Guard or Reserves only,
see instruction guide.
O Yes O No - Skip to 19

b. Was active-duty military service during —

Fill a circle for each period in which this person served. O May 1975 or later O Vietnam era (August 1964-Aprtl 1975) C February 1955—July 1964 O Korean conflict (fune 1950-lonuory 1955) O World War II (September 1940-luly 1947) | O Vior\c\ War \ (April 1917-November 1918) O Any other time

19. Does this person have a physical, mental, or other health condition which has lasted for 6 or more months and which ...

a. limit* the kind or amount — ^

of work this person can do at a lob? o O

b. Prevents this person from working at a lob? o O

c. Limiti or prevents this person

from using public transportation? ^ ^

20. If this person Is a female- None 12 3 4 5 6 How many babies has she ever Q O O O O O O had, not counting stillbirths?

Do not count her stepchildren 7 8 9 10 11 12 or

or children she has adopted. O O O O O O

21. If this person has ever been married

Has this person been married more than once? o

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More than once

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22a. Did this person work at any time last week?

O Yes - Fill this circle If this O No - Fill this circle

-J. person worked full if this person

■■ time or part time. did not work,

(Count part-time work or did only own

such os delivering papers, housework,

or helping without pay In school work,

a family business or form. or volunteer

Also count active duty work.
In the Armed Forces.)

Skip to 25

b. How many hours did this person work last week (at all lobs)? Subtract any time off; odd overtime or extra hours worked.

Hours

23. At what location did this person work last week? If this person worked at more than one location, print where he or she worked most last week.

If one location cannot be specified, see instruction guide. a. Address (Number and street)

If street address is not known, enter the building name, shopping center, or other physical location description.

b. Name of city, town, village, borough, etc.

c. Is the place of work inside the incorporated (legal) limits of that city, town, village, borough, etc.? O Yes O No, in unincorporated area

d. County

24a. Last week, how long did it usually take this person to get from home to work (one way)?

Minutes

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(1) State, foreign country,

Puerto Rico, — Guam, etc.:

(2) County:

(3) City, town,

village, etc.;

(4) Inside the incorporated (legal) limits
of that city, town, village, etc.?

O Yes O No, in unincorporated area

. Month and year
of marriage?

Month and year
of first marriage?

(Month)

(Year)

(Month)

(Year)

c. If married more than once - Did the first marriage
end because of the death of the husband (or wife)?

O Yes o No

86

Measuring America

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29. Occupation

a. What kind of work was this person doing?

{For example: Registered nurse, personnel manager, supervisor of order department, gasoline engine assembler, grinder operator)

b. What were this person's most important activities or duties?

jFor example: Patient care, dlrectinghlrlng policies, supervising
order clerks, assembling engines, operating grinding mill)

30. Was this person — (Fill one circle)
Employee of private company, business, or _

individual, for wages, salary, or commissions o ^

Federal government employee O

State government employee O

Local government employee (city, county, *tc.) O

Self-empioyed in own business,

professional practice, or farm —

Own business not incorporated o

Own business incorporated O

Working without pay in family business or farm O

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O No - Skip to 31d

b. How many weeks did this person work in 1979? Count paid vacation, paid sick leave, and military sovict.

c. During the weeks worked in 1979. how many hours did this person usually work each week?

d. Of the weeks not worked in 1979 (it any), how many weeks was this person looking lor work or on layoff from a job?

Weeks

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lncome in 1979 —

Fill circles and print dollar amounts.

ff net lncome was o loss, write "Loss" above the dollar amount. lf exact amount Is not known, give best estimate. For lncome received Jointly by household members, see lnstruction guide.

During 1979 did this person receive any income from the following sources?

]f "Yes" to any of the sources below - How much did this person receive for the entire year? a. Wages, salary, commissions, bonuses, or tips from

all jobs . . . Report amount before deductions for taxes, bonds, dues, or other items.

O Yes O No

S .00

(Annual amount Dollars)

b. Own nonfarm business, partnership, or professional

practice . . . Report net lncome a-er business expenses.

_ O Yes -*

TM O No

(Annual amount

.00 Dollars)

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9 9 9

(Annual amount - Dollars)

OR O None

lf total amount was a loss,
write "Loss"above amount.

S :i.

9 9

8 .-:

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•♦ Please turn to the next page and answer the questions for Person 2 on page 2

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b. Last year, 1979, did sales of crops, livestock, and other farm products from this place amount to —

O Less than $50 (or None) O $250 to $599 O $1,000 to $2,499

O $50 to $249 — O $600 to $999 O $2,500 or more

H16. Do you get water from —

O A public system (city water deportment, etc.) or private company?

O An individual drilled well?

O An individual dug well?

0 Some other source (a spring, creek, river, cistern, etc.)?

H17. Is this building connected to a public sewer?

O Yes, connected to public sewer

O No. connected to septic tank or cesspool

O No, use other means

H18. About when was this building originally built? Mark when the building was

first constructed, not when It was remodeled, added to, or converted.

H21a. Which fuel is used most for house heating?

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Gas: from underground pipes

serving the neighborhood Gas: bottled, tank, or LP Electricity Fuel oil, kerosene, etc. I

Coal or coke
Wood
Other fuel
No fuel used

b. Which fuel is used most for water heating?

CENSUS USE

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O Gas: from underground pipes

serving the neighborhood 0 Gas: bottled, tank, or LP O Electricity O Fuel oil, kerosene, etc.

O Coal Dr coke

O Wood

O Other fuel

O No fuel used

c. Which fuel is used most for cooking? O Gas: from underground pipes

serving the neighborhood
O Gas; bottled, tank, or LP
O Electricity
C; Fuel oil, kerosene, etc. I

C Coal or coke

O Wood

O Other fuel

O No fuel used

H22- What are the costs of utilities and fuels for your living quarters? a. Electricity

$ 00 OR (-■ Included in rent or no charge

JlZ~^r.'Z~t G Electricity not used

Average monthly cost

b. Gas

$ .00 OR

"Average monthly cost

C included in rent or no charge O Gas not used

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c. Water

$

00 OR ^ 'included in rent or no charge

Yearly cost

d. Oil, coal, kerosene, wood, etc.

$ 00 OR O Included in rent or no charge Yearly cost __

O These fuels not used

H23. Do you have complete kitchen facilities? Complete kitchen facilities are a sink with piped water, a range or cookstove, and a refrigerator.

O Yes Ho No

H24. How many bedrooms do you have?

Count rooms used mainly for sleeping even If used also for other purposes.
O No bedroom o 2 bedrooms O 4 bedrooms
O 1 bedroom O 3 bedrooms O 5 or more bedrooms

H25. How many bathrooms do you have?

A complete bathroom Is a room with flush toilet, bathtub or shower, and
wash basin with piped water.

A half bathroom has at least a flush toilet or bathtub or shower, but does
not have all the facilities for a complete bathroom.

O No bathroom, or only a half bathroom

O 1 complete bathroom

O 1 complete bathroom, plus half bath(s)

O 2 or more complete bathrooms

H26. Do you have a telephone in your living quarters?
O Yes ■ O No

H27. Do you have air conditioning?

O Yes, a central air-conditioning system
O Yes, 1 individual room unit
O Yes, 2 or more individual room units
O No

H28. How many automobiles are kept at home for use by members
of your household?

O None | O 2 automobiles

O 1 automobile O 3 or more automobiles

H29. How many vans or trucks of one-ton capacity or less are kept at

home for use by members of your household?

O None O 2 vans or trucks

O 1 van or truck O 3 or more vans or trucks

H22d.

0 O G 0

1 I 1 I c S £ c 3 3 3 3

6 6 6 G

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OO0© I I I I c c £ c 3 3 3 3 P. A. Tl- cc

5 5 5 5

6 6 6 G ????

ssss

9559

0 0 0 G

1 I I I £ c & 8 3 3 3 3 er >q. ec or

5 5 5 5

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7 ?? 7 3SS8 9 9 9 9

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