<br />Census Information Sheet – CONFIDENTIAL <br /> <br /> <br />Please complete the attached survey and return it with your annexation application. It is not necessary to <br />include the names of all individuals. Addresses and number of people living at each address is essential and sex <br />and age information is helpful. If you have any questions, please contact the Planning Department at 541‐682‐ <br />5377. <br /> <br /> <br />City of Eugene Address: <br /> <br />HOUSING TYPE TENURE <br />Single Unit Structure ( ) Owner‐Occupied ( ) <br />Multiple Unit Structure ( ) Renter‐Occupied ( ) <br />Trailer or Mobile Home <br />Seasonal <br />( ) Vacant <br />( ) <br />( ) <br />RESIDENTS <br /> <br /> <br />Last Name First Name Sex Age <br />Respondent <br />2. <br />3. <br />4. <br />5. <br />6. <br />7. <br />8. <br />9. <br />10. <br /> <br /> <br />Portland State University School of Urban and Public Affairs <br />Center for Population Research and Census (503) 725‐3922 <br />