1930 Census Extraction Form
Page 2 of 3Today’s date / Enumerated on: / Microfilm Roll Number
Or
Ancestry.com Image Identification
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State / Enumerator
County / Enumeration District:
Township or Other Division / Supervisor’s District:
Incorporated Place / Unincorporated Place
Ward of City / Block # / Institution
The name of every person whose place of abode on January 1, 1930, was with this family. Enter surname first, then the given name and middle initial, if any. Omit children born since January 1, 1930. / Place of Birth / Mother Tongue / Citizenship
Person / Father / Mother / Language spoken in home before coming to the United States / Code (for office use only) / Year of immigration to U.S. / Naturalization / Able to speak English
State or M.T. / County / Nativity