The Census of 1910
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.
Location:
____ Street, avenue, road, etc.
____ House number (in cities and towns).
1. ____ 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.
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.
Nativity:
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.
Citizenship:
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.
Occupation:
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.
Education:
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.