1910 Census Form
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1Pg.
Dwelling No.
Family No.
Sex
Color
Age
Marital Status?
No. years married
No. of children
mothered
How many still alive?
Place of Birth
Father’s place of birth
Mother’s place of
birth?
Immigration year to
U.S.
Naturalized?
Native Language
General nature of
industry
Employer, employee,
or self-employed?
Out of work April 15?
No. weeks unemployed
Can read
Can write
In school since 9/09?
Owned or rented?
Free or mortgaged?
Farm or house?
No. of farm
Civil War veteran?
Deaf, dumb, or blind?
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