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Annual Resident Listing Form
Your Name
First*
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Last*
Gender*
SELECT ONE
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Present Residential Address*
(No P.O. boxes or business addresses)
Street Number & Name*
Apartment or floor
Neighborhood*
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ZIP Code*
Present Mailing Address
(If different from above)
Street Number & Name
Apartment or floor
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(If different)
Your Birth Date
Month*
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31
Year*
----
1900
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1911
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1914
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Occupation*
Telephone Number*
(Digits only)
Number of Dogs
(If any)
0
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Veteran
Yes:
No:
US citizen*
Yes:
No:
E-Mail*
*Note: Fields marked with asterisk symbol(*) are mandatory fields
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©2008 The City of Boston
©2008 The City of Boston
