The Census of 1910

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Schedule No. 1 - Population.

State __________, County ________________.
Supervisor's District No. _____; Enumeration District No. ______.
Township or other division of county [Insert proper name and, also, name of class, as township, town, precinct, district, hundred, beat, etc..] _________. Name of incorporated place ________________. Ward of city _________________.
Name of institution, _____________________.
Enumerated by me on the __ day of June, 1910, ____________________________, Enumerator.

  1. Location:
    Street, avenue, road, etc.
    House number (in cities and towns)

    Number of dwelling in order of visitation
  2. Number of family, in order of visitation
  3. Name of each person whose place of abode on April 15, 1910, was in this family. Enter surname first, then the given name and middle initial, if any. Include every person living on April 15, 1910. Omit children born since April 15, 1910
  4. Relationship of this person to the head of the family
    Personal description:
  5. Sex
  6. Color or race
  7. Age at last birthday
  8. Whether single, married, widowed, or divorced
  9. Number of years of present marriage
    Mother of how many children:
  10. Number born
  11. Number now living
    Place of birth of each person and parents of each person enumerated. If born in the United States, give the state or territory. If of foreign birth, give the Country
  12. Place of birth of this person
  13. Place of birth of father of this person
  14. Place of birth of mother of this person
  15. Year of immigration to the United States
  16. Whether naturalized or alien
  17. Whether able to speak English; or, if not, give language spoken
  18. Trade or profession of, or particular kind of work done by this person, as spinner, salesman, laborer, etc.
  19. General nature of industry, business, or establishment in which this person works, as cotton mill, dry goods store, farm, etc.
  20. Whether an employer, employee, or working on own account.
    If an employee:
  21. Whether out of work on April 15, 1910
  22. Number of weeks out of work during year 1909
  23. Whether able to read
  24. Whether able to write
  25. Attended school any time since September 1, 1909
    Ownership of home:
  26. Owned or rented
  27. Owned free or mortgaged
  28. Farm or house
  29. Number of farm schedule.
  30. Whether a survivor of the Union or Confederate Army or Navy.
  31. Whether blind (both eyes).
  32. Whether deaf and dumb.

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