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<br /> L _
<br /> Person 1
<br /> 5. Please provide information for each person living here. If 9. What is Person 1's race?
<br /> there is someone living here who pays the rent or owns this Mark one or more boxes AND print origins.
<br /> residence, start by listing him or her as Person 1. If the
<br /> owner or the person who pays the rent does not live here, ❑ White-Print, for example, German,Irish,English,Italian,
<br /> start by listing any adult living here as Person 1. Lebanese,Egyptian,etc.
<br /> What is Person 1's name?Print name below. —-
<br /> First Name MI
<br /> u Black or African Am.—Print,for example,African American,
<br /> �l Jamaican,Haitian,Nigerian,Ethiopian,Somali,etc.
<br /> Last Name(s)
<br /> -
<br /> 1 American Indian or Alaska Nativ t am p,enrolled or
<br /> principal tribe(s),for example,-f tion,Blackfeet Tribe,
<br /> Mayan,Aztec,Native Vill okt � (nupiat Traditional
<br /> 6. What is Person 1's sex?Mark X ONE box. n' etc.AW
<br /> ( ' Male Female
<br /> �_� Government, Nome � o Con
<br /> I
<br /> ❑ J- es� ^❑ Vietnamese ❑ Native Hawaiian
<br /> 7. What is Person 1's age and what is Person 1's date of \�`/'/
<br /> birth?For babies less than 1 year old, do not write the age in ❑ Korean [� Samoan
<br /> months. Write 0 as the age.
<br /> Print numbers in boxes. ndian ❑ Japanese 1 Chamorro
<br /> Age on April 1,2020 Month Day Year of birth Other Asian— i. ! Other Pacific Islander—
<br /> Print,for example, Print,for example,
<br /> Pakistani, Cambodian, Tongan, Fijian,
<br /> years Hmong,etc. Marshallese,etc.
<br /> 4 NOTE;Please answer BOTH Question u is .�-
<br /> origin and Question 9 about race.Fe i c s,Hispanic f l Some other race-Print race or origin.
<br /> origins are not races.
<br /> 8. Is Person 1 of Hispanic,Lati sh origin?
<br /> ❑ No,not of Hispa 'c L tin nish origin
<br /> ❑ Yes,MeA i Chicano
<br /> ❑ Ye 'P cn
<br /> ❑ s, b n
<br /> ❑ Yes, nother Hispanic,Latino,or Spanish origin—Print,for
<br /> example,Salvadoran,Dominican, Colombian, Guatemalan,
<br /> Spaniard,Ecuadorian,etc.
<br /> If more people were counted in Question 1 on
<br /> the front page,continue with Person 2 on the
<br /> next page.
<br />. 2
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