Questionnaire Text

Questionnaire form view entire document:  text  image

12a. Did ____ live in this house five years ago (April 1, 1975)?

If in college or Armed Force in April 1975, report place of residence there.
[] Born April 1975 or later -- Turn to next page for next person
[] Yes, this house -- Skip to 13
[] No, different house


12b. Where did ____ live five years ago (April 1, 1975)?

(1) Name of municipality, U.S. state, Virgin Islands, or foreign country: ____
(2) Name of barrio or U.S. county ____
(3) Name of city, town or village ____