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od RNew. 7. ons te wean Bok thyg 4- ¥00 (Moe [a Ss ~ Washington Civil Disorder Survey Tracking Form Survey File Wo, 22S PR Survey Staff Person with Primry Responsibility. LY vasiness on [J Property ~ SR Survey Staff Person with Secondary Responsibility. C&AC = Completeness and Accuracy Check. By Date init: eee rene lookahead yaa aaa gaat na ad ee LT Wwaostionnaire Non-Response File: 2, ‘Tracking Form ONLY Received PR tly 3. Further Identificstion and Call-Packs: A. Started PR Oe B. Questionnaire Re-miling Request Made to CONTROL PR C. Contact Notes FR PR PR » Continued Over, PR Foy aatested aS Be chee naMalad Taker lodctoye)=[=h=is[oleI1< 4, Questionnaire Received OR If Filled Out by PR, Reported to CONTROL PR 5. Questionnaire Examined: Identification Checked; If Incorrect, Reported to CONTROL CT Ne Damage or Loss; File Returned te CONTROL & Terminated eR Bie or Loss; Reported to CONTROL for Agency Inf. Form a ofa cae ciramie Complete; No Call-Backs Needed . YEF Muestionmire Incomplete; Cell-Backs Needed 6. CalleBaeks: A. Started B. Contact Notes: | Continued Over. BBR838 3 S38 35 C, Call-Fecks a1 jst ionna: % tions of Other Affected Businesses or Properties Found: No oR [7] Yes, Reported to CONTROL FR Z9, 8, Completed Questionnaire Referred FR fh 9. Questionnaire Received for CAAC a 2 Se CAAC Completed; Questionnaire Returned to FR 2 So 10, Questionnaire Recoived rm Additional Work, If Amy, and Questionneire Completed Rm ge pS RS MB feMeweMet Neue te ola) -1= 12) -Ielese)=/ clon Towation Tnformtion Recorded PR DUC BD Information Recorded FR v SOC, SEC. Informtion Recorded a 12, EDP Coding Sheet Completed PR 13, Entire File Referred 10: SR for C&AC PR 14, Entire File Received for C&AC SR C&AC Completed; Entire File Returned to PR SR 15. Entire File Received PR ‘Additional Work, If Any, and File Certified Completed and Forewarded to CONTROL PR \x6, Entire File Received; Entry Inde on Control Sheets Control EDP Coding Sheet Forewarded for EDP Control ALL Other Materials Filed Control File heck by PR: 1. [J Tracking Form; 2, [J] Cuestionraire; ‘Agency Information Form; and 4, [J EDP Coding Sheet. Ad » District of Columbia Civil Disturbance Report Business Information Survey 860 eee O25 ‘couplete one of these forms for each business establishnent you are associated with ained any physical danage or theft, however minor, during the recent civil disturbance Mietrict of Columbia. If an establishment you are associated with sustained no physical theft at all, please complete Items 1,2, and 3 only and return the form. A business Mtrsiment is defined as any comercial enterprise or unit at ono address. If you need nore Piplease call Mice Geraldine Johnson, D.C. Redevelopment Land Agency, telephone: 362-6950 isinese Establishment: 1. Names, 2. Address:_Z)_ 3 se Date First Denage or Theft Ooourre 5. betel) Subsequent Danages or Thefts Occurred, If Anyt Business Omer (or Principal Officer): 6. Mane: 7. Ager/ [7 Under 30; £7 30 to 50; fever 50. a. Race: {7 white; Lf-Negro; [7 other. 9» Hone Adaross: (4b CE See Manager of Establishment (If Different from Owner): 10. Names, Le Ages ja under 30; £7 30 to 50; [7 Over 50. 22s they 7 wosees EF wares _ [7 ove See Capi eet MON) os prover LE LL ILD wf Tpke Batadligheent Wao Located at Thig Address OR in Thig_lmediate Neighborhoods Atter 1965; £7 1960 to 1965; £7 1950 to 19595 1940 to 19493 L/ Before 1940. 15,/omership of Business: £7 Sinile Proprietorship; [7 Partnership; [7 Corporation; Other ~ Specify, 16. Type of Establishment Operations (Check All Ly 2, Appropriate Boxea): Hope Than SO-Forcent Lae Than 50 Fereent of Dollar Value of _of Dollar Value of alee Sales As Manufacturing By Wholesale Trade C. Retail Trade D, Service oe ByWarehousing p « LA: Other — 128 sn LUE Loaner 2 17. Specify Principal Product or Services, Local Be Y on to th efvil disturbange, aid the business: £7 Om ox EP maT the p & cor Aaiment?” If the-pronises were rented, How much rene feo paid? yy Vig Total Annual Rent: § 20,00 20, Totel Floor Area! ann 2 fetal Foor areas 5) , If the Premises were rented for this establishment, has there been any change up to now in the zental status of the establishment as a result of the civil disturbanc No Change l Disineas or Stablistment. Sold Lease Terminated Rent, Increased and Sstablishnent Still in Business Rent, Decreased and Bstablishnent Still in Business Establishment is Out of Business, But Continuing to Pay Same Rent Bstablishnent is Out of Business, But Paying Lover Rent Other - Specifys, a p3 Approxinate Gross Sales of This Establishnent During Last Tax Year: $. eo. 2he Approxinate Taxable Incone from This Establishnent During Last Tax Yearr’4 ie ZL. & 3 65¢trace Avea of This Bstablishnent Before Civil Disturbance (Check All Appropriate Boxes): Primary Market Secondary _Narket(s: Hore Than $0 Percent Less Than 50 Percent ‘of Total Dollar: of Total Dollar Value of Sales Value of Sales Saipser Whotesales Jager Yeeiastle @ / 1, seoeciate Yetgnornoed (ithin 20 Blocks) By Larger Section of District of Columbia y. All of District of Columbia . Parts or All of Washington Metropolitan Area ‘B. Larger Region Including Wash. Metrop. Area “approximate Nunber of Square Feet of Floor Space Now Occupied by This seronsomees Lb2yy + Employment of Establishment During Full Work Week Before Civil Disturbance: iber_of Persons White Negro ‘Other Total / Vale Female Fonale Wale Female Wale Female /. Paid and Unpaid Family Workers (Including Owner) B. Part-time Paid Employees (Less Than 40 Hours) | WR ie fe ho PE |b || 11 & C. Full-time Paid Employees (40 Hours or More a. Managerial & Professional b. Clerical ce Sales 4, Craftsmen & Other Skilled e+ Drivers & Other Semi-skilled £, Laborers & Other Unskilled itit ea Pret eas ELI % | eo €. Full-time Subtotal (__) (__) e [ PCP 4 H seasua si SE loyment of Establishment During Most Recent Full Work Week: Number of Persons White Wegro Other, Total Hale Female fale Female Wale Female Wale Fenale oY A. Paid and Unpaid Family Workers (Including Omer) B. Part-time Paid Tmployees (Less ‘Than 40 Hours) [eel ll C. Full-time Paid Employees (40 Hours or More) a. Managerial & Professional b. Clerical c. Sales d. Craftemen & Other Skilled e,Drivers & Other Semi-skilled Laborers & Other Unskilled Pitti PUI IU C p E | H iployees of this establishment were transferred to other locations of your Sf any, as a result of damage fron the civil disturbance? wyagx

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