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Last name
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First name Middle Initial
"In Question 1 ... please list each person who was living here on Wednesday, April 1, 1970, or who was staying or visiting here and had no other home.
"LIST IN QUESTION 1: Family members living here, including babies still in the hospital; Relatives living here; Lodgers or boarders living here; Servants or hired hands living here; Other persons living here; College students who stay here while attending college, even if their parents live elsewhere; Persons who usually live here but are temporarily away (including children in boarding school below the college level); Persons with a home elsewhere but who stay here most of the week while working.
"DO NOT LIST IN QUESTION 1: Any person away from here in the Armed Forces; Any college student who stays somewhere else while attending college; Any person who usually stays somewhere else most of the week while working there; Any person away from here in an institution such as a home for the aged or mental hospital; Any person staying or visiting here who has a usual home elsewhere.
"Note: If everyone here is staying only temporarily and has a usual home elsewhere, please fill this circle [] and give their names ... in the space for question 12. [Questions 9 to 12 were asked to ensure a complete count. We omit them below.] Do not answer any other questions. Mail back the form on Wednesday, April 1."