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���� �� IIIIIIII 111111 IIIIIIIII 111111 IIIIIIIIIIIII VIII IIIIIIIIII�IIIIIIIIIIIII IIIIIIIIIIIIIII ������ ������ ����� ����� <br /> . m�������� ���IIIIIIIII 1111111 IIIIIIIIIIII 11111111111111 IIII111111111 <br /> How Ion have111111 11111o111u been living in this <br /> VIII More than 10 <br /> g y g <br /> One year or less F-11-5 years ❑6-10 years ❑ <br /> community? years <br /> Do,you awn or,rent/Iease Your residence? Own ent/Lease <br /> ❑ ❑ <br /> Do you currently work inside the city? F]Yes ❑No, outside the F-I No, 1 am FI/am retired <br /> city unemployed <br /> What is your age group? <br /> 1 to 24 35 to 44 55 to 54 75 or,alder <br /> F-I ❑ ❑ 0 <br /> F-I 25 to 34- ❑45 to 4 ❑ 5 to 75- <br /> Which of the following categories best ❑Some high ❑High school ❑Some ❑College ❑Graduate <br /> describes your level of education? school graduate college graduate degree(s) <br /> Which of the following categories includes F-I 2 000 or less F X50-$10C?000 ver$150 000 <br /> 1 . , ❑ , <br /> your total family income la t:y ar? <br /> $2 561 0 0 ❑$100-$1,501,000 <br /> Please indicate your marital status: FISingle ❑Married/living with ❑Widowed/separated/ <br /> partner divorced <br /> Mark-the.......boxes that descr be the,......people I ivi ng <br /> in your house(other than yourself and/or,a Cfi1d(ren)age 12 C�hild(ren)over, Parent ages or None,of these <br /> spouse). Check all that apply. or under age 12 - older, <br /> What is your gender? F]Ma/e ❑ <br /> Please check all that apply: To' which groups) A 1 n BlaclklAfrican American <br /> Oh er n❑ sa ❑ ❑ ❑ t e <br /> do you belong? Amencan Indian7Alaska <br /> lvhit /C auc, s an NativeINati e <br /> His anic/Latino <br /> Hawaiian <br /> (c)2010 Cobalt Community Research Page 8 <br />