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2A
SR
PR
- Survey s .rr Perso
th Pr y ponsibility.
th ,.. conda.rz Responsibility.
Business .Q! J2J a Property
C&AC - Coap1 ten nd Accuracy Check. B,y !!l!. Initials
• • • • • • • • • • • • •
for PR
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Control
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12. EDP Coding Sheet Completed PR
13. Entire File Referr d TO: _ _ _ _ _ _ _ _ _ _ _ SR for C&AC PR
16. Entire File Received; Entry »tde on Control She ts Control ;dj_ /:'~
EDP Coding Sheet Forew~rded tor EDP Control
All other M.teriAls Filed Control
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File C011pleteness Check bz PR: 1. 0 Trscking Form; 2. 0 Questionn&ire;
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Agency Inror tion For m.; and 4. 0 EDP Coding Sheet.
\
District of Columbia
Civil Disturbance Report
Business Information Survey
Please complete ~ of these forms for each business establishment you are associated with
that sustained ~ physical damage or theft, however minor, during the recent civil disturbance
in the District of Columbia. If an establishment you are associated with sustained no physical
damage or theft at all, please complete Items l, 2, and 3 only and return the form. A business
establishment is defined as a.ny commercial enterprise or unit at one address. If you need more
forms, please call Miss Geraldine Johnson, D.C. Redevelopment Land Agency, telephone: 382-6950.
24. A~te Taxable Income from This Establishment During Last Tax Year: $ · .~
Trade Area of This Establishment Before Civil Disturbance (Check All Appropriate Boxes):
Primary Market SecondarY Market(s)
~~ More Than 50 Percent Less Than 50 Percent
of Total Dollar of Total Dollar
Value of Sales Value of Sales
Consumer Wholesale Consumer Wholesale
(1) (2) (3) (4)
•
B.
ediate Neighborhood (Within 10 Blocks)
rger Section of District of Columbia
~ ~ ~ ~
C. All of District of Columbia
D. Parts or All of Washington Metropolitan Area
~Larger Region Including Wash. Metrop. Area
26.~roximate Number of Square Feet of Floor Space Now Occupied qy This Establishment: ~c?CJ
27. Employment of Establishment During Full Work Week Before Civil Disturbance:
Number of Persons
White Negro Other Total
Male Female Male Female Male Female Male Female
(Inctuding Owner)
Part-time Paid Employees ~
'
-I-
Than 40 Hours)
/
A. Paid and Unpaid Family Workers
White
Male Female
IIL
Negro
Male Female
(2) Dr
Other
V~le Female
(4) ill: (6) m=
Total
Male Female
(8)
(Including Owner)
B. Part-time Paid Employees (Less -I- -1-
Than 40 Hours)
C. Full-time Paid Employees (40
Hours or More) :
a. Managerial & Professional
b. Clerical
c. Sales
d. Craftsmen & Other Skilled ~
e. Drivers & Other Semi-skilled
f. Laborers & Other Unskilled G-- -1-
Uti
D. ESTABLISHMENT TOTAL
29. How many employees of this establishment were transferred to other loc~tions
business, if any, as a result of damage from the civil disturbance? --~----~'---- persons /
30. How many employees of this establishment, if any, did your fi~ he
1 .P /. find jobs iWith
businesses because of damage from the civil disturbance? II ' - per ons
31. Type of Damage or Loss (Check All Appropriate Boxes): (1) (2)
Limited Extensive
A. Breakage of Glass
B. Theft of Merchandise
C. Smoke Damage
D. Water Damage
E. Fire Damage
8 Present
F. Other - Specify:
Conditio~ of ~emises:
L:7 ~e~rs
L:7 Demolished; L:7 No
Underway;
j
Repairs Undertaken;
"{' Repairs Compl!eted. ,
33. Present Status of Business: L:7 Closed; L:( In P~ial
Operation; LJ7 In Full Operation;
L:7Moved Business or Establishm~;~ations to Another Location.
If the business or establishment operations were moved to another location, please indicate
where? L:7 In the Same Neighborhood; L:7
Elsewhere in D.C.; Outside D.C. L:7
f)F?Atent of Financial Loss (Please Estimate, If Necessar,y):
(1) (2)
Stock or Inventory Fixtures & Equipment
$""
--- ..-
-
$ ftJ()
J6. Has the insurance on this establishm~nt been changed sinre the civil disturbance?
D Cancelled; D Reduced; D Other - Specify:_:........-_ __.__........,.::...o....._..;,_,--------41
37. Future Plans (Even Though Plans May Be Tentative):
11 Business or Establishment
Other - Specify:----------------------------------------------------------------
38. What reasons are the most important in selecting one of the above alternatives over the
otqers for you, your business or es ablishment? (Please explain and use the reverse side
of this page, if needed.) ____~~~~--------------------------------------------------
39. Check the appropriate box below if you wish information about any of the following:
Small Business Administration programs
Assistance in finding a new location
Retraining or employment assistance ~~~
Other assistance, such as legal or accounting - Specify: ______¥ _ _~ ---~-----------------