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Dwelling / Family Number:            / 

Name:                               
Immigrant ID:                       
Sex:                                
Age:                                 years 
Birth Date:                         
Relationship to Head of Household:  
Marital Status & Children:          
Occupation:                         
Home Address:                       
Birth Place:                        
Year of Immigration:                
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Comments:
                                    

Census household:

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Action	Name	Relationship	Age	Sex	Birth Place	Year of Immigration	Citizenship Status	Comments	Immigrant ID
	Mardirossian [Mardirosian], Jacob	head	30	M
	Harry, John	boarder	27	M	Turkey	1890	naturalized
	Bagdasarian [Baghdasarian], Andrew	boarder	16	M	Turkey	1892	alien
	Bagdasarian [Baghdasarian], Andies	boarder	28	M	Turkey	1897	alien
	Maldonian [Meldonian], Muhson	boarder	32	M	Turkey	1893	alien
	Misakian, Elizar	boarder	28	M	Turkey	1888	alien		LAQT-14JUL1901-0-F-0024,LSVO-17OCT1908-3-9-0002
	Jacobson [Hagopian], Peter	boarder	28	M	Turkey	1885	alien
	Mirigian [Mirakian], Ciragos	boarder	23	M	Turkey	1895	alien
	Monogian [Manougian], M. K.	boarder	28	M	Turkey	1897	alien
	Chapaman [Chobanian], A. B.	boarder	37	M	Turkey	1891	alien	[age & birth year are inconsistent]
	Harry, Charles	boarder	20	M	Turkey	1890	alien
	Mazadoorian [Medzadourian], Gragos	boarder	35	M	Turkey	1892	alien