The distrcit clerk should fill out two annual reports. One should be sent to the county superintendent of schools between the 10th and 25th days of July, and the other retained in his possession. The district slerk must keep one complete census list of all the children in the district (Clank Form No. 2) and give it to the teacher at the beginning of the school year, a list of the persons of school age residing in the district.
Lodges or boarders must not be enrolled in the shcool census of the district where they are merely lodging or boarding. Neither must person of school age be so enrolled, who may be employed for a limited and reeasonably defninte time in one school district whose parents reside in another.
Persons of school age who devote a part of their time to service to pay for their board and lodging, while the remainder is spent in attendance at school, and who are actually residing in the district "for other, as a main purpose, than to participate in the advantages which the school affords," and those of shcool age who have no other legal residence are considered members of the families with whom they reside and schould be included in the district census.
Place an asterisk (*) opposite the line containing the name of a child who is deaf or blind. Also write before the number whether the child is deaf or blind.
| Names of parents of other persons with whom the children live | PO address
(give street no or RFD route) |
Distance from schoolhouse | Names of children between 4 & 20 years | Age in years | Date of birth | Sex | Public school only | Both public and parochial school | Private or parochial school only |
| F. Schmallfeldt | Salem R 29 | 1/2 | George | 18 | 1900/Sept/22 | M | X | X | X |
| same | same | same | Elmer | 13 | 1904/Dec/14 | M | X | X | X |
| same | same | same | Irma | 9 | 1908/Sept/23 | F | yes | . | . |
| J. Madden | Salem 29 | 1/4 | Emma | 14 | 1903/Nov/21 | F | . | yes | . |
| same | same | same | John | 10 | 1907/Sept/5 | M | yes | . | . |
| C. Schultz | Bristol 30 | 4 | Claude | 10 | 1907/Sept/8 | M | yes | . | . |
| A. Burdick | Salem 29 | 1/2 | Vera | 17 | 1900/July/11 | F | X | X | X |
| H.E. McVicar | Salem 29 | 1/2 | Eddie | 14 | 1903/Aug/14 | M | yes | X | X |
| same | same | same | Arthur | 6 | 1912/Jan/5 | M | yes | X | X |
| F. Johnson | Salem 29 | 2 | Eleanor | unreadable | 1905/Nov/15 | F | yes | X | X |
| J. Lynch | Bristol 30 | 4 | Marie | 7 | 1910/Oct/4 | F | yes | X | X |
| same | same | same | Jerome | 6 | 1911/Nov/23 | M | X | X | X |
| same | same | same | Frances | 5 | 1913/Nov/8 | F | X | X | X |
| M. Reiter | Bristol 30 | 4 | Clarence | 10 | 1907/June/21 | M | X | yes | X |
| same | same | same | Leo | 11 | 1906/Oct/22 | M | X | yes | X |
| same | same | same | Antoinette | 8 | 1909/Nov/10 | F | X | yes | X |
| same | same | same | Catherine | 6 | 1911/Sept/2 | F | yes | X | X |
| H. Rieter | Salem 29 | 1/2 | Harry | 10 | 1907/Oct/8 | M | yes | X | X |
| C. Giglinski | Salem 29 | 1/4 | Lucille | 4 | 1913/Aug/24 | F | yes | X | X |
| G. Walbert | Salem 29 | 1/8 | Clide | 9 | 1908/April/7 | M | yes | X | X |
| same | same | same | Andrew | 4 | 1914/April/20 | M | X | X | X |
Summary
| . | Boys | Girls | Total |
| No. of childre residing in the district | 12 | 9 | 21 |
| No. between 7 and 14 | 7 | 4 | 11 |
| No. between 14 and 16 | 1 | 1 | 2 |
| Attended both public and parochial school during the year | 2 | 2 | 4 |
| No. of such between 7 and 14 | 2 | 1 | 3 |
| No of such between 14 and 16 | 0 | 1 | 1 |
| No. who attended parochial school only | 0 | 0 | 0 |
| No. of such between 7 and 14 | 0 | 0 | 0 |
| No. of such between 14 and 16 | 0 | 0 | 0 |
| No. of children residing more than 2 miles from schold but not more than 3 | . | . | 0 |
| No. of schildren residing more than 3 miles from school | . | . | 8 |