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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
Yon
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 SEloyment 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