Form LS-3 Person record
What is this person's name?
KentFirst name
DietzLast name
What is this person's date of birth and age?
August 4, 2004Date of birth
22Age
What is this person's sex?
- Male (selected)
- Female
What is this person's race or origin?
- White (selected)
- Black or African American
- American Indian or Alaska Native
- Asian
- Hispanic or Latino
- Two or more races
Where does this person live?
Rochester, NHCity and state
RuralSetting
Is this home owned or rented?
- Owned
- Rented (selected)
Mobile HomeKind of home
What is the highest degree or level of school this person has finished?
High School GraduateEducation
Does this person work?
Employed at a large companyWork status
Monday-Friday, 7:00 to 18:00Schedule
What was this person's income in the last 12 months?
$31,860Total income
Is this person now married?
- Now married (selected)
- Not married
Geraldine Dietz, 22Spouse