1. Name of the home or farm: ______________________________
2. Full name of each person in the household: __________________
3. Status in household for each household member: ______________
4. Age of each household member: ______________
5. Marital status: ____________________________
6. Occupation or industry: _____________________
7. Total number of people
Eunice Kennedy Shriver National Institute of Child Health and Human Development,
National Science Foundation,
The Church of Jesus Christ of Latter-Day Saints, and
University of Minnesota.
Copyright © Minnesota Population Center, University of Minnesota.