UNITED STATES DEPARTMENT OF COMMERCE Economics and Statistics Administration

U.S. Census Bureau

Washington, DC 20233-0001

OFFICE OF THE DIRECTOR

www.census.gov/2010census

March 15, 2010

A message from the Director, U.S. Census Bureau ...

This is your official 2010 Census form. We need your help to count everyone in the United States by providing basic information about all the people living in this house or apartment. Please complete and mail back the enclosed census form today.

Your answers are important. Census results are used to decide the number of representatives each state has in the U.S. Congress. The amount of government money your neighborhood receives also depends on these answers. That money is used for services for children and the elderly, roads, and many other local needs.

Your answers are confidential. This means the Census Bureau cannot give out information that identifies you or your household. Your answers will only be used for statistical purposes, and no other purpose. The back of this letter contains more information about protecting your data.

USCENSUSBUREAU

census' 2010

D-16(L) (6-26-2009)

Your Answers Are Confidential

Federal law protects your privacy and keeps your answers confidential (Title 13, United States Code, Sections 9 and 214). The answers you give on the census form cannot be obtained by law enforcement or tax collection agencies. Your answers cannot be used in court. They cannot be obtained with a Freedom of Information Act (FOIA) request.

As allowed by law, census data becomes public after

72 years (Title 44, United States Code, Section 2108).

This information can be used for family history and

other types of historical research.

Please visit our Web site at <www.census.gov/2010census> and click on "Protecting Your Answers" to learn more about our privacy policy and data protection.

D-16(L) (6-26-2009)

TO RESIDENT AT

SAN FRANCISCO, CA 94103

If your enclosed postage-paid envelope is missing, please mail your completed form to:

U.S. Census Bureau National Processing Center 1201 East 10th Street Jeffersonville, IN 47132

If you need help completing this form, call 1-866-872-6868 between 8:00 a.m. and 9:00 p.m., 7 days a week. The telephone call is free.

TOO - Telephone display device for the hearing impaired. Call 1-866-783-2010 between 8:00 a.m. and 9:00 p.m., 7 days a week. The telephone call is free.

(.NECESITA AYUOA? Si usted necesita ayuda para completar este cuestionario, IIame al 1-866-928-2010 entre las 8:00 a.m. y 9:00 p.m., 7 dfas a la semana. La IIamada telef6nica es gratis.

The U.S. Census Bureau estimates that, for the average household, this form will take about 10 minutes to complete, including the time for reviewing the instructions and answers. Send comments regarding this burden estimate or any other aspect of this burden to: Paperwork Reduction Project 0607-0919-C, U.S. Census Bureau, AMSD-3K138, 4600 Silver Hill Road, Washington, DC 20233. You may e-mail comments to «Paperworkfscensus.qov»; use "Paperwork Project 0607-0919-C" as the subject.

Respondents are not required to respond to any information collection unless it displays a valid approval number from the Office of Management and Budget.

. U.S DEPARTMENT OF COMMERCE

Uruted. States· Economics and Statistics Administration

nsus This is the official form for all the people at this address. US CENSUS BUREAU

2010 It is quick and easy, and your answers are protected by law.

Ise a blue or black pen.

Start here

he Census must count every person living in the United tates on April 1, 2010.

ietore you answer Question 1, count the people living in

lis house, apartment, or mobile home using our guidelines.

• Count all people, including babies, who live and sleep here most of the time.

'he Census Bureau also conducts counts in institutions nd '?ther places, so:

• Do not count anyone living away either at college or in the Armed Forces.

• Do not count anyone in a nursing home, jail, prison, detention facility, etc., on April 1, 2010.

• Leave these people off your form, even if they will return to live here after they leave college, the nursing home, the military, jail, etc. Otherwise, they may be counted twice.

he Census must also include people without a permanent lace to stay, so:

• If someone who has no permanent place to stay is staying here on April 1, 2010, count that person. Otherwise, he or she may be missed in the census.

How many people were living or staying in this house, apartment, or mobile home on April 1, 2010?

Number of people =

Were there any additional people staying here

April 1, 2010 that you did not include in Question 1? Mark X all that apply.

Children, such as newborn babies or foster children Relatives, such as adult children, cousins, or in-laws Nonrelatives, such as roommates or live-in baby sitters People staying here temporarily

No additional people

Is this house, apartment, or mobile home - Mark X ONE box.

Owned by you or someone in this household with a mortgage or loan? Include home equity loans.

Owned by you or someone in this household free and clear (without a mortgage or loan)?

Rented?

Occupied without payment of rent?

What is your telephone number? We may call if we don't understand an answer.

Area Code + Number

1MB No. 0607-0919-C: Approval Expires 12/31/2011.

Form D·1 (12-5-2008)

SCENSUSBUREAU

5. Please provide information for each person living here. Start with a person living here who ,owns or rents this house, apartment, or mobile home. If the owner or renter lives somewhere else, start with any adult living here. This will be Person 1.

What is Person 1 's name? Print name below.

Last Name

First Name

6. What is Person 1 's sex? Mark X ONE box.

Male Female

7. What is Person 1 's age and what is Person 1 's date of birth?

Please report babies as age 0 when the child is less than 1 year old.

Print numbers in boxes.

Age on April 1, 2010 Month Day Year of birth

MI

.. NOTE: Please answer BOTH Question 8 about Hispanic origin and Question 9 about race. For this census, Hispanic origins are not races.

8. Is Person 1 of Hispanic, Latino, or Spanish origin?

No, not of Hispanic, Latino, or Spanish origin Yes, Mexican, Mexican Am., Chicano

Yes, Puerto Rican

Yes, Cuban

Yes, another Hispanic, Latino, or Spanish origin - Print origin, for example, Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on. i

9. What is Person 1 's race? Mark X one or more boxes.

White

Black, African Am., or Negro

American Indian or Alaska Native - Print name of enrolled or principal tribe. i

Asian Indian Japanese

Chinese Korean

Filipino Vietnamese

Other Asian - Print race, for example, Hmong, Laotian, Thai, Pakistani, Cambodian, and so on. i1

Native Hawaiian Guamanian or Chamorro Samoan

Other Pacific Islander - Print race, for example, Fijian, Tongan, and so on. i1

Some other race - Print race. i?

10. Does Person 1 sometimes live or stay somewhere else?

No Yes - Mark X all that apply.

In college housing In the military

For child custody In jailor prison

At a seasonal In a nursing home

or second residence For another reason

.. If more people were counted in Question 1, continue with Person 2.

Print name of Person 2

Last Name

First Name MI

How is this person related to Person 1? Mark ~ ONE box.

Husband or wife

Biological son or daughter Adopted son or daughter Stepson or stepdaughter Brother or sister

Father or mother Grandchild

Parent-in-law

Son-in-law or daughter-in-law Other relative

Roomer or boarder Housemate or roommate Unmarried partner

Other nonrelative

What is this person's sex? Mark ~ ONE box.

Male Female

What is this person's age and what is this person's date of birth? Plea~e report babies as age a when the child is less than 1 year old.

Print numbers in boxes.

Age on April 1, 2010 Month Day Year of birth

NOTE: Please answer BOTH Question 5 about Hispanic origin and Question 6 about race. For this census, Hispanic origins are not races. Is this person of Hispanic, Latino, or Spanish origin?

No, not of Hispanic, Latino, or Spanish origin Yes, Mexican, Mexican Am., Chicano

Yes, Puerto Rican

Yes, Cuban

Yes, another Hispanic, Latino, or Spanish origin - Print origin, for example, Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on. i

What is this person's race? Mark ~ one or more boxes.

White

Black, African Am., or Negro

American Indian or Alaska Native - Print name of enrolled or principal tribe. i

1. Print name of Person 3

Last Name

First Name MI

2. How is this person related to Person 1? Mark ~ ONE box.

Husband or wife

Biological son or daughter Adopted son or daughter Stepson or stepdaughter

Parent-in-law

Son-in-law or daughter-in-law Other relative

Roomer or boarder

Brother or sister Housemate or roommate

Father or mother Unmarried partner

Grandchild Other nonrelative

3. What is this person's sex? Mark ~ ONE box.

Male Female

4. What is this person's age and what is this person's date of birt Please report babies as age a when the child is less than 1 year ole Print numbers in boxes.

Age on April 1, 2010 Month Day Year of birth

... NOTE: Please answer BOTH Question 5 about Hispanic origin and Question 6 about race. For this census, Hispanic origins are not ra

5. Is this person of Hispanic, Latino, or Spanish origin?

No, not of Hispanic, Latino, or Spanish origin Yes, Mexican, Mexican Am., Chicano

Yes, Puerto Rican

Yes, Cuban

Yes, another Hispanic, Latino, or Spanish origin - Print origin, for exan Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on. i

6. What is this person's race? Mark ~ one or more boxes.

White

Black, African Am., or Negro

American Indian or Alaska Native - Print name of enrolled or principal trib,

Asian Indian Japanese Native Hawaiian Asian Indian Japanese Native Hawaiian
Chinese Korean Guamanian or Chamorro Chinese Korean Guamanian or Chamorro
Filipino Vietnamese Samoan Filipino Vietnamese Samoan
Other Asian - Print race, for Other Pacific Islander - Print Other Asian - Print race, for Other Pacific Islander -
example, Hmong, Laotian, Thai, race, for example, Fijian, Tongan, example, Hmong, Laotian, Thai, race, for example, Fijian, Ton;
Pakistani, Cambodian, and so on. i and so on. i Pakistani, Cambodian, and so on. i and so on. i Some other race - Print race. 7

Does this person sometimes live or stay somewhere else?

No Yes - Mark ~ all that apply.

In college housing In the military

At a seasonal

or second residence

For child custody In jailor prison

In a nursing home For another reason

If more people were counted in Question 1 on the front page, continue with Person 3.

Some other race - Print race. 7

7. Does this person sometimes live or stay somewhere else?

No Yes - Mark ~ all that apply.

In college housing In the military

At a seasonal

or second residence

For child custody In jail or prison

In a nursing home For another reason

... If more people were counted in Question 1 on the front page, continue with Person 4.

name of Person 4

Name

Name MI

is this person related to Person 1? Mark X ONE box.

lusband or wife

:iological son or daughter .dopted son or daughter .tepson or stepdaughter irother or sister

ather or mother lrandchild

Parent-in-law

Son-in-law or daughter-in-law Other relative

Roomer or boarder Housemate or roommate Unmarried partner

Other nonrelative

t is this person's sex? Mark X ONE box.

lale Female

t is this person's age and what is this person's date of birth? :;e report babies as age 0 when the child is less than 1 year old.

. Print numbers in boxes.

on April 1, 2010 Month Day Year of birth

:: Please answer BOTH Question 5 about Hispanic origin and

tion 6 about race. For this census, Hispanic origins are not races. is person of Hispanic, Latino, or Spanish origin?

10, not of Hispanic, Latino, or Spanish origin

'es, Mexican, Mexican Am., Chicano

'es, Puerto Rican

'es, Cuban

es, another Hispanic, Latino, or Spanish origin - Print origin, for example, rgentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on. ¥

t is this person's race? Mark X one or more boxes. ilhite

lack, African Am., or Negro

rnerican Indian or Alaska Native - Print name of enrolled or principal tribe. ¥

1. Print name of Person 5

Last Name

First Name MI

2. How is this person related to Person 1? Mark X ONE box.

Husband or wife

Biological son or daughter Adopted son or daughter Stepson or stepdaughter Brother or sister

Father or mother Grandchild

Parent-in-law

Son-in-law or daughter-in-law ather relative

Roomer or boarder Housemate or roommate Unmarried partner

Other nonrelative

3. What is this person's sex? Mark X ONE box.

Male Female

4. What is this person's age and what is this person's date of birth?

Please report babies as age 0 when the child is less than 1 year old.

Print numbers in boxes.

Age on April 1, 2010 Month Day Year of birth

_. NOTE: Please answer BOTH Question 5 about Hispanic origin and Question 6 about race. For this census, Hispanic origins are not races,

5. Is this person of Hispanic, Latino, or Spanish origin?

No, not of Hispanic, Latino, or Spanish origin Yes, Mexican, Mexican Am., Chicano

Yes, Puerto Rican

Yes, Cuban

Yes, another Hispanic, Latino, or Spanish origin - Print origin, for example, Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on. ¥

6. What is this person's race? Mark X one or more boxes.

White

Black, African Am., or Negro

American Indian or Alaska Native - Print name of enrolled or principal tribe, ¥

stan Indian Japanese Native Hawaiian Asian Indian Japanese Native Hawaiian
.hinese Korean Guamanian or Chamorro Chinese Korean Guamanian or Chamorro
ilipino Vietnamese Samoan Filipino Vietnamese Samoan
ither Asian - Print race, for Other Pacific Islander - Print Other Asian - Print race, for Other Pacific Islander - Pm»
~ample, Hmong, Laotian, Thai, race, for example, Fijian, Tongan, example, Hmong, Laotian, Thai, race, for example, Fijian, Tongan,
akistani, Cambodian, and so on. ¥ and so on. ¥ Pakistani, Cambodian, and so on. ¥ and so on. ¥ ome other race - Print race. i?

I this person sometimes live or stay somewhere else?

o Yes - Mark X all that apply.

In college housing In the military

At a seasonal

or second residence

For child custody In jailor prison

In a nursing home For another reason

re people were counted in Question 1 on the front page, nue with Person 5.

Some other race - Print race. i?

7. Does this person sometimes live or stay somewhere else?

No Yes - Mark X al/ that apply.

In college housing In the military

At a seasonal

or second residence

For child custody In jailor prison

In a nursing home For another reason

_. If more people were counted In Question 1 on the front page, continue with Person 6.

1. Print name of Person 6

Last Name

First Name MI

2. How is this person related to Person 1? Mark X ONE box.

Husband or wife

Biological son or daughter Adopted son or daughter Stepson or stepdaughter Brother or sister

Father or mother Grandchild

Parent-in-law

Son-in-law or daughter-in-law Other relative

Roomer or boarder Housemate or roommate Unmarried partner

Other non relative

3. What is this person's sex? Mark X ONE box.

Male Female

4. What is this person's age and what is this person's date of birth?

Please report babies as age a when the child is less than 1 year old.

Print numbers in boxes.

Age on April 1, 2010 Month Day Year of birth

... NOTE: Please answer BOTH Question 5 about Hispanic origin and Question 6 about race. For this census, Hispanic origins are not races.

5. Is this person of Hispanic, Latino, or Spanish origin?

No, not of Hispanic, Latino, or Spanish origin Yes, Mexican, Mexican Am., Chicano

Yes, Puerto Rican

Yes, Cuban

Yes, another Hispanic, Latino, or Spanish origin - Print origin, for example, Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on. '1

6. What is this person's race? Mark X one or more boxes.

White

Black, African Am., or Negro

American Indian or Alaska Native - Print name of enrolled or principal tribe. '1

Asian Indian

Japanese

Native Hawaiian Guamanian or Chamorro Samoan

Other Pacific Islander - Print race, for example, Fijian, Tongan, and so on. ¥

Chinese Korean

Filipino Vietnamese

Other Asian - Print race, for example, Hmong, Laotian, Thai, Pakistani, Cambodian, and so on. ¥

Some other race - Print race. iZ

7. Does this person sometimes live or stay somewhere else?

No Yes - Mark X all that apply.

In college housing In the military

At a seasonal

or second residence

For child custody In jailor prison

In a nursing home For another reason

... If more than six people were counted In Question 1 on the front page, turn the page and continue.

Form D·1 (12·5·2008)

-+ If more people live here, turn the page and continue.

Use this section to complete information for the rest of the people you counted in Question 1 on the front page. We may call for additional information about them.

son 7 Last Name First Name MI
Age on April 1, 2010 Date of Birth Related to Person 1?
lIale Month Day Year Yes
:emale No
s-on 8 Last Name First Name MI
Age on April 1, 2010 Date of Birth Related to Person 1?
lIale Month Day Year Yes
:emale No
son 9 Last Name First Name MI
Age on April 1, 2010 Date of Birth Related to Person 1?
lIale Month Day Year Yes
-emale No
son 10 Last Name First Name MI
Age on April 1, 2010 Date of Birth Related to Person 1?
iIlale Month Day Year Yes
-emale No
son 11 Last Name First Name MI
Age on April 1, 2010 Date of Birth Related to Person 1?
iIlale Month Day Year Yes
-ernale No
son 12 Last Name First Name MI
Age on April 1, 2010 Date of Birth Related to Person 1?
vlale Month Day Year Yes
:emale No
FOR OFFICIAL USE ONLY
Thank you for completing your official JIC1 JIC2
2010 Census form.