Census ID:                          

Country (Census Year):              
Census Place:                       
Page Number (Enumeration Date):     
Line Number:                        
Dwelling / Family Number:            / 

Name:                               
Immigrant ID:                       
Sex:                                
Age:                                 years  months

Relationship to Head of Household:  
Marital Status & Children:          
Occupation:                         
Home Address:                       
Birth Place:                        
Father's Birth Place:               
Mother's Birth Place:               
Year of Immigration:                
Citizenship Status:                 

Comments:
                                    

Census household:

Actions:
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Action	Name	Relationship	Age	Sex	Birth Place	Year of Immigration	Citizenship Status	Comments	Immigrant ID
	Marderosian [Mardirosian], Charley	head	40	M	Erzurum, Turkey	1904	alien
	Marderosian [Mardirosian], Ogaper	wife	37	F	Erzurum, Turkey	1913	alien
	Marderosian [Mardirosian], Hagaz	son	5	M	IL, USA			birthplace: Erzurum
	Marderosian [Mardirosian], Hrair	son	3-6m	M	IL, USA
	Marderosian [Mardirosian], Zerair	son	2	M	IL, USA			birthplace: Erzurum