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<br /> 1. Print name of Person 6 7. What is this person's race?
<br /> First Name MI Mark❑X one or more boxes AND print origins.
<br /> ❑ White-Print,for example,German,Irish,English,Italian,
<br /> Lebanese,Egyptian,etc.
<br /> Last Name(s) -
<br /> ❑ Black or African Am.-Print,for example,African American,
<br /> 2. Does this person usually live or stay somewhere else? Jamaican,Haitian,Nigerian,Ethiopian,Somali,etc.
<br /> Mark U all that apply.
<br /> No
<br /> ❑ American Indian or Alaska Native-Print name of enrolled or
<br /> I- Yes,for college ❑ Yes, with a parent or principal tribe(s),for example,Navajo Nation,Blackfeet Tribe,
<br /> other relative Mayan,Aztec,Native Village of Barrow Inupiat Traditional
<br /> Yes,for a military assignment ❑ Yes, at a seasonal or Government,Nome Eskimo Community,etc.
<br /> second residence - -
<br /> i 3 Yes,for a job or business
<br /> ❑ Yes, in a fail or prison
<br /> Yes, in a nursing home l Yes,for another reason
<br /> ❑ Chinese ❑ Vieth s O Native Hawaiian
<br /> 3. How is this person related to Person 1?MarkZX ONE box. �I Filipino ran l Samoan
<br /> Opposite-sex husband/wife/spouse LJ Father or mother Asian Indian J e n Chamorro
<br /> U Opposite-sex unmarried partner Grandchild Other.Asian- I I Other Pacific Islander-
<br /> 1 Same-sex husband/wife/spouse Print,�forgxample, Print,for example,
<br /> Parent-in-law f'a istl,'Gambodian, Tongan, Fijian,
<br /> otc- Marshallese, etc.
<br /> U Same-sex unmarried partner Son-in-law or daughter-in-law -_ _ _
<br /> ❑ Biological son or daughter ❑ Other relative
<br /> ❑ Adopted son or daughter ❑ Roommate or housern a Some other race-Print race or origin.7
<br /> ❑ Stepson or stepdaughter ❑ Foster child
<br /> ❑ Brother or sister ❑ Othe relati
<br /> 4. What is this person's sex?Mark X D
<br /> Male Female
<br /> Q
<br /> 5. What is this person's'acta is this person's date of
<br /> birth?For babies l��s G�ha 1 old,do not write the age in
<br /> months. Write O as
<br /> Print numbers in boxes.
<br /> Age on n Month Day Year of birth
<br /> ears
<br /> 4 NOTE:Please answer BOTH Question 6 about Hispanic
<br /> origin and Question 7 about race.For this census,Hispanic
<br /> origins are not races.
<br /> 6. Is this person of Hispanic,Latino,or Spanish origin?
<br /> IJ No,not of Hispanic,Latino,or Spanish origin
<br /> ❑ Yes,Mexican,Mexican Am.,Chicano
<br /> ❑ Yes,Puerto Rican
<br /> I Yes,Cuban
<br /> Yes,another Hispanic,Latino,or Spanish origin-Print,for
<br /> example,Salvadoran,Dominican, Colombian, Guatemalan,
<br /> Spaniard,Ecuadorian,etc. -� If more people were counted in Question 1 on
<br /> the front page, continue with Person 7 on the
<br /> _ next page.
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