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|Males under fourteen ||Males of fourteen and Under twenty-six || Males of twenty-six and under forty-five || Males of forty-five and upwards || Females under fourteen ||Females of fourteen and Under twenty-six || Females of twenty-six and under forty-five || Females of forty-five and upwards ||
 
|Males under fourteen ||Males of fourteen and Under twenty-six || Males of twenty-six and under forty-five || Males of forty-five and upwards || Females under fourteen ||Females of fourteen and Under twenty-six || Females of twenty-six and under forty-five || Females of forty-five and upwards ||
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| Name of Street. || House Number. || Is the person on the day of the Enumerator’s visit] sick or temporarily disabled, so as to be unable to attend to ordinary business or duties? If so, what is the sickness or disability? || Blind. || Deaf and Dumb. || Idiotic. || Insane. || Maimed, Crippled, Bedridden, or otherwise disabled. || Attended school within the Census year. || Cannot read. || Cannot write. || Place of Birth of this person, naming State or Territory of United States, or the Country, if of foreign birth. || Place of Birth of the FATHER of this person, naming the State or Territory of United States, or the Country, if of foreign birth. || Place of Birth of the MOTHER of this person, naming the State or Territory of United States, or the Country, if of foreign birth.
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