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Survey File No.

2A
SR
PR
- Survey s .rr Perso
th Pr y ponsibility.
th ,.. conda.rz Responsibility.
Business .Q! J2J a Property
C&AC - Coap1 ten nd Accuracy Check. B,y !!l!. Initials
• • • • • • • • • • • • •
for PR
• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •
Control
1
1;t_ ~
£:TQuestionnaire Non-Response File:

2. Tracld.ng Fo ONLY Rece ed PR

3. Further ld ntifi tion ~ 11-Backs:


A. started PR
B. Questio ire Re- iling Request Hlde to CONTROL PR
c. Contaot Not s: PR
PR
PR
- - - - - - - - - - - - - - - . . . . . ; • Continued Over. PR
• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •
{;!Returned Qn ionnaire Fil :
4. Questi OJU'lAire Recei 9!, If Filled Out by PR, Reported to CONTROL PR

s. PR

OR
a !E. . PR

- ~ Dr.t•,!.!. or Loss; R por o CONTROL for Ag•ncy Int. Form


d PR
U Que tio!mlire C mpl t ; No C&ll-Blcks Needed PR
.2!! Inco lete; 11-&cks Ne ded PR

6. Olll-B!cks: PR
B. Con PR
PR
PR
PR
PR

••••
8. Complet
• 0
Que
•••••••••••••••
iormaire
p •••
L_· _ ;_ __
TO: __
PR
PR
~i{f_
/1 ~ 115
9. SR
oPR SR

PR
10.
Questi ire Completed PR (J z_(,~
• • • • • • • • • • • • •• • • • • • • • • • • • • • • • •••
11.
PR
PR
PR
12. EDP Coding Sheet Completed PR
13. Entire File Referr d TO: _ _ _ _ _ _ _ _ _ _ _ SR for C&AC PR

14. Entire File Received for C&A.C SR


C&-.c Comple d; Entire Fil Returned to PR SR

15. Entire File Receiv d PR


Additi o~l Wo k, If ~y. and F 1 Certified Completed
tt nd Forew... rded to CONTROL PR

16. Entire File Received; Entry »tde on Control She ts Control ;dj_ /:'~
EDP Coding Sheet Forew~rded tor EDP Control
All other M.teriAls Filed Control
• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •
File C011pleteness Check bz PR: 1. 0 Trscking Form; 2. 0 Questionn&ire;
3. U
Agency Inror tion For m.; and 4. 0 EDP Coding Sheet.

\
District of Columbia
Civil Disturbance Report
Business Information Survey

Please complete ~ of these forms for each business establishment you are associated with
that sustained ~ physical damage or theft, however minor, during the recent civil disturbance
in the District of Columbia. If an establishment you are associated with sustained no physical
damage or theft at all, please complete Items l, 2, and 3 only and return the form. A business
establishment is defined as a.ny commercial enterprise or unit at one address. If you need more
forms, please call Miss Geraldine Johnson, D.C. Redevelopment Land Agency, telephone: 382-6950.

Business Establishment: 1. Name:


--:/)~/11/\tr(
---
~ (/ .,/..~;-f\ o"""'
''I
----~----------~------------------~~-----------------
2. Address: / /;2-4 -z"%5 £ ,/1/;tft/ ·
~
¥-:nate First Damage or Theft Occurred: 73 J / y({
--~~--~--~~~~~~~----~----------
5. Date ( s) Subsequent Damages or Thefts Occurred, If _J.ny;_;f '--tr·-.,1.. .;~
. . !·._,..1~-'-' ---'------------
Busines~r (or Principal Officer) : 6. Name: e/o...,..IfIf( /E ,J)!: /;;ill Iff I
I • ge: ~ Under 30; ~ 30 to 50; ~ver 50.
,S: Race: ~ White; ~gro; D Other. j
9yHome Address: /12 &-«.!,; 5!/, ?(W~ui!fJ;;..,0·~·2DCXJ/ Phone: 1J uZ, 5/9!;
' 1age.rl'of Establi·shment (If Different from Owner): 10. Name:_-..:-o::):.....;;..a.;;.
?a -';,;..;;.;;;__...lo.....;:;;:;;.._ _ _ _ _ _ __

?1• Age: ~ Under 30; ~ 30 to 50; ~ Over 50.


14. Race: ~ White; ~ Negro; ~ Other.
&
tf' Home Address: Phone: _ _ _ _ __

14. VD~Establishment Was Located at Th~dress OR in This Immediate Neighborhood:


~ After 1965; ~ 1960 to 1965; ~ 1950 to-r959; L:7 1940 to 1949; L:7 Before 1940.
15. Ownership of Business: ~ Single Propr~etorship;
L:7 Partnership; L:7
Corporation;
Other - Specify: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
L:7
16. Type of Establishment Operations (Check All (1) (2)
Appropriate Boxes): More Than 50 Percent Less Than 50 Percent
of Dollar Value of of Dollar Value of
Sales Sales .
Manufacturing
Wholesale Trade
Retail Trade
D. Service
E. Warehousing rj) / 7/
F. Other - Specify: /""00 J\ 0 0 fif.
-2-

.8. Prior to the civ


this establis
disturbance, did the business: L:7 OWN Qr ~the premises for
If the premises were rented, how much rent was paid?
~ 'i'otal Annual Rent: ~ I · '· . __
]?;(. Total Floor Area: (..1
( Square Feet
~ Annual Rent Per Square Foot: $ /2: .tz_
22. If the premises were rented for this establishment, has there been any change up to now in
the renta tatus of the establishment as a result of the civil disturbance:
No Change
Business or Establishment Sold
Lease Terminated
Rent Increased and Establishment Still in Business
Rent Decreased and Establishment Still in Business
Establishment is Out of Business, But Continuing to Pay Same Rent
Establishment is Out of Business, But Paying Lower Rent
Other - Specify=--------------------------------------------------------------
~p oxllnate Gross Sales of This Establishment During Last Tax Year: $ ;;lt("tJt> (jD

24. A~te Taxable Income from This Establishment During Last Tax Year: $ · .~
Trade Area of This Establishment Before Civil Disturbance (Check All Appropriate Boxes):
Primary Market SecondarY Market(s)
~~ More Than 50 Percent Less Than 50 Percent
of Total Dollar of Total Dollar
Value of Sales Value of Sales
Consumer Wholesale Consumer Wholesale
(1) (2) (3) (4)


B.
ediate Neighborhood (Within 10 Blocks)
rger Section of District of Columbia
~ ~ ~ ~
C. All of District of Columbia
D. Parts or All of Washington Metropolitan Area
~Larger Region Including Wash. Metrop. Area

26.~roximate Number of Square Feet of Floor Space Now Occupied qy This Establishment: ~c?CJ
27. Employment of Establishment During Full Work Week Before Civil Disturbance:
Number of Persons
White Negro Other Total
Male Female Male Female Male Female Male Female

Paid and Unpaid Family Workers


rrr=(2) m=
(4) ill:=
(6) I7L (8)

(Inctuding Owner)
Part-time Paid Employees ~
'
-I-
Than 40 Hours)

Full-time Paid Employees (40


Hours or More):
a. Managerial & Professional
b. Clerical
c. Sales
d. Craftsmen & Other Skilled
e. Drivers & Other Semi-skilled
f. Laborers & Other Unskilled

(,.t)S C, Full-time Subtotal ( _ ) ( _ ) ( ) (_) (_) (_)


=
D. ESTABLISHMENT TOTAL
-3-

28. Employment of Establishment During Most Recent Full Work Week:


Number of Persons

/
A. Paid and Unpaid Family Workers
White
Male Female
IIL
Negro
Male Female
(2) Dr
Other
V~le Female
(4) ill: (6) m=
Total
Male Female
(8)

(Including Owner)
B. Part-time Paid Employees (Less -I- -1-
Than 40 Hours)
C. Full-time Paid Employees (40
Hours or More) :
a. Managerial & Professional
b. Clerical
c. Sales
d. Craftsmen & Other Skilled ~
e. Drivers & Other Semi-skilled
f. Laborers & Other Unskilled G-- -1-
Uti

C. Full-time Subtotal ( __ ) ( __ ) ~----------


(_) (_)

D. ESTABLISHMENT TOTAL

29. How many employees of this establishment were transferred to other loc~tions
business, if any, as a result of damage from the civil disturbance? --~----~'---- persons /
30. How many employees of this establishment, if any, did your fi~ he
1 .P /. find jobs iWith
businesses because of damage from the civil disturbance? II ' - per ons

31. Type of Damage or Loss (Check All Appropriate Boxes): (1) (2)
Limited Extensive

A. Breakage of Glass
B. Theft of Merchandise
C. Smoke Damage
D. Water Damage
E. Fire Damage

8 Present
F. Other - Specify:
Conditio~ of ~emises:
L:7 ~e~rs
L:7 Demolished; L:7 No
Underway;
j
Repairs Undertaken;
"{' Repairs Compl!eted. ,
33. Present Status of Business: L:7 Closed; L:( In P~ial
Operation; LJ7 In Full Operation;
L:7Moved Business or Establishm~;~ations to Another Location.

If the business or establishment operations were moved to another location, please indicate
where? L:7 In the Same Neighborhood; L:7
Elsewhere in D.C.; Outside D.C. L:7
f)F?Atent of Financial Loss (Please Estimate, If Necessar,y):
(1) (2)
Stock or Inventory Fixtures & Equipment

A. Value Prior to Civil Disturbance $ - .- $ --...... .- $ ttJIJ


B. Value of Damage or Loss from
Civil Disturbance
c. Amount of Insurance Coverage
$
$ -- ..-
-
~

$""
--- ..-
-
$ ftJ()

D. Insurance Compensation Received


Up to Now $
--- .- $
,___.-
-4-

J6. Has the insurance on this establishm~nt been changed sinre the civil disturbance?
D Cancelled; D Reduced; D Other - Specify:_:........-_ __.__........,.::...o....._..;,_,--------41
37. Future Plans (Even Though Plans May Be Tentative):
11 Business or Establishment

/ Remain Open for Business at Same Location


Reopen for Business at Same Location
Relocate Business or Establishment Elsewhere in Same Neighborhood
Relocate Business or Establishment Outside of Former Neighborhood, But Inside D.C.
Relocate Business or Establishment Outside of D.C.
Simp~ Go Out of Business

Other - Specify:----------------------------------------------------------------
38. What reasons are the most important in selecting one of the above alternatives over the
otqers for you, your business or es ablishment? (Please explain and use the reverse side
of this page, if needed.) ____~~~~--------------------------------------------------

39. Check the appropriate box below if you wish information about any of the following:
Small Business Administration programs
Assistance in finding a new location
Retraining or employment assistance ~~~
Other assistance, such as legal or accounting - Specify: ______¥ _ _~ ---~-----------------

Do Not Write Below This Line


A. Square:
B. Lot(s):
C. St./No.:
D. Bldg. No.:
E. DUC ID:
F • .PA:
G. EM:
H. SIC: