Group Quarters

Draft 2 (5-9-2017)

AN EQUAL OPPORTUNITY EMPLOYER

U.S. Department of Commerce
Economics and Statistics Administration
U.S. Census Bureau

YOUR RESPONSE IS
REQUIRED BY LAW

OFFICIAL BUSINESS
Penalty for Private Use $300

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DH-5(GQ) (5-2017)

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1201 E 10th Street
Jeffersonville IN 47132

Size 9 -1/2 x 4-1/8 with covered window 1-5/8 x 5

PRESORTED
FIRST-CLASS MAIL
POSTAGE & FEES PAID
U.S. CENSUS BUREAU
PERMIT NO. G-58

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