Questionnaire Text

2000 5%
top
2000 5%
Questionnaire form view entire document:  text  image

15. b. Where did this person live 5 years ago? Name of city, town, or post office
[ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]
Did this person live inside the limits of the city or town?
[] Yes
[] No, outside the city/town limits
Name of county
[ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]
Name of state
[ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]
ZIP Code
[ ][ ][ ][ ][ ]