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1910 U.S. census extraction form

Copy one household exactly as written, spelling and all. Ages count from census day, April 15, 1910. Column groups follow our 1910 census guide.

State
County
Town, township or ward
Page, sheet or line numbers
Enumerator, date of visit
Where viewed (archive, film, website)
#Name and relationship to the head of the familySex, color or race, ageMarital statusNumber of years of present marriageNumber of children born, and number now livingPlace of birth and mother tongue of the person, father, and motherYear of immigration, naturalized or alien, speaks EnglishOccupation, industry, employer or employee, out of work on April 15, weeks out of work in 1909Can read, can write, attended school since September 1, 1909Home owned or rented, free or mortgaged, farm or houseSurvivor of the Union or Confederate Army or NavyBlind; deaf and dumb
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Notes

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