1900 Census Form
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1Pg.
Dwelling No.
Family No.
Color
(White, Black, Japanese,
Chinese, American Indian)
Sex
Date of Birth
Age
Single, married,
widowed, divorced?
No. years married
Mother of how many
children?
How many children
still alive?
Place of Birth
Father’s place of birth
Mother’s place of
birth?
Immigration year to
U.S.
No. years in U.S.
Naturalization
No. mos. unemployed
No. of months in
school last year
Can read
Can write
Can speak English
Home owned or
rented?
If owned, mortgaged?
Farm or house?
No. of farm scheduled
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