Form LS-3 Person record
What is this person's name?
MoisesFirst name
AmbrosioLast name
What is this person's date of birth and age?
August 18, 1968Date of birth
58Age
What is this person's sex?
- Male (selected)
- Female
What is this person's race or origin?
- White
- Black or African American
- American Indian or Alaska Native
- Asian
- Hispanic or Latino (selected)
- Two or more races
Where does this person live?
North Terre Haute, INCity and state
RuralSetting
Is this home owned or rented?
- Owned
- Rented (selected)
HouseKind of home
What is the highest degree or level of school this person has finished?
No High School DegreeEducation
Does this person work?
Employed at a large companyWork status
Monday-Friday, 9:00 to 16:00Schedule
What was this person's income in the last 12 months?
$86,318Total income
Is this person now married?
- Now married (selected)
- Not married
Addie Ambrosio, 59Spouse