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Show HI! 00 GOMIIIE0 ? awma r-r-j The 1970 Census is now almost finished. It is very important fjj l fffrj I that the census be complete and correct. If ycu believe that IT ?-i"ZVlfjr. Pfi you (or anyone else in your household, including visitors) i ' T3?rl rgt-' I were NOT counted, please fill out the form below and mail it j yvj (Insert address) y -, ! I PLEASE PRINT OR WRITE CLEARLY I I I have checked with the members of my household, and I believe that one (or more) of us was NOT counted in the 1970 Census. i I On April 1, 1970, 1 lived at ! (House number) (Street or road) (Apartment number or location) I I (City) (County) (State) (ZIP code) i This address is located between and i (Name of street or road) (Name of street or road) J i I am listing below the name and required information for myself and each member of my household. j PLEASE INCLUDE I DO NOT INCLUDE I All family membsrs and other relatives living here, In- i Any college student who stayj somewhere else while attend- I eluding babies. I ng college. ! no" re'utfvTs' UA?'"'' "mh h" '". T " '"'"l k' "l, '," ! I Institution such as a home lor the aged or mental hospital. I All persons who usually live here but are temporarily away. ! All persons with a home elsewhere but who stay here most ! yP'"'' who usually stays somewhere .Is. most of th. , ! of the week while working or attending college. ! week whl" w0,kln ,he j I Anyone staying or visiting here who had no other home. Any person visiting here who has usual home elsewhere. j I NAMES OF PERSONS LIVING IN THIS HOUSEHOLD ON I Prim r.lorlonihlpl l this per.on- I I I. this per. on- ! APRIL 1, 1970, AND THOSE STAYING OR VISITING of each perion to I HERE WHO HAD NO OTHER HOME. the hood of th. Whit. Now married I I f Hood of th. household hou.ehold. Nooro (Block) Wldow.J ! Wif.ofh.od Mats Arn.rleon Indlon Widowed I Pfi"n"hiTS Unr"'-''d children, oldest fir For example: f" 1""' Wh.n wa. thl. Divo,cod j 1 S I Worried children ond their fomiliei "i'e Femolo cn,""" person born? c , j I j ortyer Oth.r relative, of th. h.od Son, Daughter F,UP'"0 Separated , I I Persons not related to the head Grandson M orF Hawoilan Single (never 1 ,. , , , , , Mother-in-low ni"", . married) I ( you list more than 6 persons, use on additional sheet) Lodger Other (print I rT.T" Lodger1: wife specific j . Loitnom. Fir. t name I, , rOCe'' Month I Year I I 1 ln'""1 i I II I 1 I I HEAD ! I , 1 1 1 I I I I I I I 1 I 1 I 1 I II I 1 1 1 I II I I II I I 1 1 1 I II I I j I I I I I ! I II I j 1 I 1 I , I I I Name of person Who filled this form: NOTICE - Your answers nre CONFIDTNTIAL. The law (Titlo 13. I United States Code) requires that you answer Xlio questions to tha I I best of your knowlcdp.ri. Yolit answers will be used only for I I V. . s. f,l .',;m,n, co lu, lHm II,,,, , J statistical purposes and cannot, by law, ba disclosed to any ' I i ,,,, O-'s', person outside the Ccnsu3 Hurcau for any reason whatsoever. I I j 1 ' I ' Cut atimQ dutteil lino- 1 s 1 New banking 9 to 3 hOUrS Monday fit Tuesday Wednesday FIRST y Thursday SECURITY BANK A , 9 to 6 Friday Moab EFFECTIVE MAY 1st |