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  District:                         County:                        State:    
  Date: 1840                       Ass't Marshall:                           
      Line No:                 (printed)Page No:                             
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     Lastname:                             Firstname:                        
                                                                             
         Free White Persons, Including Heads of Families                     
                                                                             
                  Ŀ                   
           Males                                               
                                     
                                                                             
                                                                             
                  Ŀ                   
          Females                                              
                                     
                                                                             
                                                                             
                                                                             
         Free Colored Persons                           Slaves               
      Males              Females              Males              Females     
ĿĿ ĿĿ
                                                 
 ٺ
                                                                             
 Pensioners for Revolutionary or Military Services included in the foregoing:
    Names:                                      Ages:                        
                                                                             
    Total Persons in Household: [  ]                                         
                                                                             
 Number of Persons in Family Employed in:                                    
    Mining[  ],  Agriculture[  ],  Commerce[  ],  Manufactures and Trades[  ]
    Navigation of the Ocean[  ],  Navigation of Canals, Lakes, and Rivers[  ]
    Learned Professions and Engineers[  ]                                    
                                                                             
 Deaf and Dumb, Blind, and Insane White Persons, included in the foregoing:  
    Deaf and Dumb:    Under 14[  ],  14 & Under 25[  ],  25 and Upward[  ]   
    Insane and Idiots:    At Private Charge[  ],  At Public Charge[  ]       
                                                                             
 Schools, etc.                                                               
    Universities or Colleges:      Number of students[  ]                    
    Academies and Grammar Schools: No. of Scholars[  ]                       
    Primary and Common Schools:    No. of Scholars[  ]                       
    No. of Scholars at Public Charge[  ]                                     
    No. of White Persons Over 20 Years of Age in Family                      
       who cannot read and write[  ]                                         
                                                                             
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Neighbors:                                                                   
                                                                             
Notes:                                                                       
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                              Field Descriptions
                      Whites                        Free Colored and Slaves
           Under  5            50 & Under 60                 Under 10
       5 & Under 10            60 & Under 70            10 & Under 24
      10 & Under 15            70 & Under 80            24 & Under 36
      15 & Under 20            80 & Under 90            36 & Under 55
      20 & Under 30            90 & Under 100           55 & Under 100
      30 & Under 40           100 & Upwards            100 & Upwards
      40 & Under 50
