Schedule 1. Free Inhabitants in _________, in the County of ________, State of _________, enumerated by me, on the _____ day of ___________, 1870.
___________________, Ass’t. Marshal.
[Inquiries number 7, 16, and 17 are not to be asked in respect to infants. Inquiries number 11, 12, 15, 16, 17, 19, and 20 are to be answered (if at all) merely by an affirmative mark, as /.]
8. Value of real estate.
9. Value of personal estate.
10. Place of birth, naming the state or territory of the United States, or the country, if of foreign birth.
11. Father of foreign birth.
12. Mother of foreign birth.
13. If born within the year, state month (Jan., Feb., etc.).
14. If married within the year, state month (Jan., Feb., etc.).
15. Attended school within the year.
16. Can not read.
17. Can not write.
18. Whether deaf and dumb, blind, insane, or idiotic.
19. Male citizens of United States of 21 years of age and upwards.
20. Male citizens of United States of 21 years of age and upwards, whose right to vote is denied or abridged on other grounds than rebellion or other crime.