Census Summary Form

Township / Community: ____________________

County: _________________________ State: _____________________

Enumerator: __________________________

Enumeration
Date: ____________________ District #: _________ Page: _______

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Head of Household: _______________________

Free White Males 16 years and up ___________

Free White Males under 16 years ___________

Free White Females _______________

All Other Free Persons ___________

Slaves ____________

Other Information _________________________________________

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19 December 2001, Will Gower