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Washington Civil Disorder Survey Tracking Form ·

PR - Survey StAff Per on with Primary Responsibility. Business .2! a Property

IJ?r
SR - SurTey stAff' Person with Seconci8.ry Responsibility.

~
C&AC - Coapleteness snd Accuracy Che
·1: ·F:i.1; As" ~;d· TO:· • • • tr · · · · · · (t~j · r~· m
• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •
.1\9"
Control tj?")._
£:TQuestionnaire No~Response File:
2. Tracking Fora ONU R eived PR

J. Furt her Identification and C.ll-&cks:


A.. started PR
B. Questionn&ire Re-•iling Request Mlde to CONTROL PR
c. ContAct Notes: PR
PR
PR
- - - - - - - - - - - - - - - . . . . . ; • Continued Over. PR
• • • • • • • •

4. QuestiODDAire Received .Q! It Filled Oat by PR, Reported to CONTROL


5. Questionnaire Emllined:
PR /6k
Identification Checked; It Inc , Reported to CONTROL PR /D
__._...._,

OR
a No DtiDilge or Loss; Flle Returned to CONTROL & Terldna ted
-
PR
- IZJ Dlllll~ or Loss; Reported to CONTROL for Agency Inf. Form PR
LJ Questiormsire Coaplete; No Call-B!lcks Needed PR
OR
- /2! Questionn.ire Incomplete; Ca.ll-Blcks Needed PR

6. Call-Backs: A. started PR
B. ContAct Notes: ~ ~ b, I
I
PR
PR
fR
• Contimled Onr. PR
c. ~ea'""!!!n!"'!:""""!-Ba~c~k-.-.-m~s-.t~i-cmna-ire~~ccm-p..
ie~ted---P PR

1. Identifications ot other Affected Businesses or Propertie s Found:


a No .Q! EJ
Yes, Reported to CONTROL
• • • • • •
PR
SR tor C&.AC PR

9. Questicmnaire Receind tor C&.A.C SR


C&:A.C C011pleted; Questiormaire RetWM<i to PR SR

10. QuestiOJmaire Reoeind PR


Additional Work, It .lJJ¥ 1 aDd Questionnaire COlllPleted fR
••• • • • • • • • • • • • • • • • • • • • • • • • • • • • • •
11. Agenoy IDtora tion For11 Completed:
Location Intoration RHorded PR
DUC BD !DtorMtion Recorded PR
soc. SEC. IlltorMtion Recorded PR

12. EDP Coding Sheet Completed PR

13. Entire File Referred TO: PR


--------------------- SR for C&AC
14. Entire File Received for C&A.C SR
C&lC Completed; Entire File Returned to PR SR

15. Entire File Received PR


Additioml Work, If Any, and File Certified Completed
"nd Forew'lrded to CONTROL PR
-
16. Entire Fil e Received; Entry Mtde on Control Sheets Control ;it_
EDP Coding Sheet Forew~rded tor EDP Cont r ol
All other M. ter1Als Filed Control
• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •
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 1. 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.

i/ ~ ~ ~
Business Establishment: 1. Name: /7 {) R:r;; it! S / h /? I f! f VpQ R <;_
!33o 'f->l ~
d ~ ~
7 7
.
1
j;Zr <dt ~;U •
-'---=---------...;:.._....;;:-----
..,f~-/7
_ _ J/ Phone ~-.1 2 7'6 ,s-c_
--

iii !td_ 0 ~
2. Address: .
4.~e First Damage or ThefHc~d: tftic- 6 P
5. ,Dat.;{s) Subsequent Damages or Thefts Occurred, If Any: ?,l- 2 2. - t{; g' 7v.s Y~
Business Owner (or Principal Officer): 6. Name: ;<fe-c&/zc:: W ffo i2 .fott/ V
,7. 1lge: D Under 30; ~30 to 50; D Over 50.
8. Race: D White; ~egro; D Other.
9 Home Address: I 72 I ..J () IVe s ):$ I< ( de (2 /?_ t::J c I, c " /Vf 0 Phone: t 5- / y<(/ 0
mager of Establi·shment (If Different from Owner): 10. J'
Name: __ ..;.._....;;~;..._-IV/
~~<:,...._________
D Under 30; D 30 to 50; D Over 50.
12. Race: D White; D Negro; D Other.
J, Home Address:
te
-------
-------------------------------------------------------
Establishment~~ Located at This Address OR in This Immediate Neighborhood:
Phone: _ _ _ _ __

D D D
7
After 1965; ~~960 to 1965; 1950 to-r959; 1940 to 1949; Before 1940.
1 ership of Business: ~ingle Propr~etorship;
D Partnership; D Corporation;
D Other - S p e c i f y = - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
e of Establishment Operations (Check All (1) (2)
propriate Boxes): More Than 50 Percent Less Than 50 Percent
of Dollar Value of of Dollar Value of
Sales Sales
A Manufacturing
B. Wholesale Trad ~
C. Retail Trade ./
D. Service _,...-
E. arehousing
F. ther - Specify: _ _ _ _ _ _ _ ___.,_ _

17. or Smice: j1/ ¥.c~ ¥::: () .f e J


-2-

... 8. the premises for

22. If the premises were rented for this establishment, has there been any change up to now in
the rent status 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: ~
l21.'..Approximate Gross Sales of This Establishment During Last Tax Year: $ [l .__
proximate Taxable Income from This Establishment During Last Tax Year: $ f£(Jl:J ··--
25. 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
Wholesale Consumer Wholesale
(2) (3) (4)

A. Immediate Neighborhood (Within 10 Blocks)


B. Larger Section of District of Columbia

j
C. All of District of Columbia
D. Parts or All of Washington Metropolitan Area
E. Larger Region Including Wash. Metrop. Area

proximate Number of Square Feet of Floor Space Now Occupied b,y This Establishment:~~~
~ployment ~/"~ ~~0
of Establishment During Full Work Week Before Civil Disturbance:

White
Number of Persons
Negro Other
1r
Total
Male Female Male Female Male Female Male Female

aid and Unpaid Family Workers


ITL (2) ill: <4) :w= <62 ill: <s2

~=
(Including Owner)
B. Part-time Paid Employees (Less
Than 40 Hours)

C. Full-time Paid Employees (40


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

C. Full-time Subtotal ( _ ) ( _ ) (_) (_) (_) (_) (_) (_)


=
D. ESTABLISHMENT TOTAL
-3-

~s. Employment of Establishment During Most Recent Full Work Week:


Number of Persons
White Negro Other Total
Hale Female Male Female rtJ.ale Female Male Female
TIL (2) IlL C4) ITI: (6) I1L (8)
A. Paid and Unpaid Family Workers
(Including Owner)
B. Part-time Paid Employees (Less
Than 40 Hours)

C. Full-time P~id Employees (40


Hours or fore) :
a. Man ~erial & Professional
b. C rical
ales
• Craftsmen & Other Skilled
Drivers & Other Semi-skilled
Laborers & Other Unskilled
______.,.,..__
C. Full-time Subtotal ( __ ) (___:) C.Q_) ( ) (_) (_) (_) (_)

D. ESTABLISHMENT TOTAL __,_


How many e~loyees of this establishment were transferred to other locations of your
busine~if any, as a result of damage from the civil disturbance? () persons
..,.,0. How many emp~oY.ees of this establishment, if any, did your firm ~lp find jobs with other
businesse because of damage from the civil disturbance? (2 persons
/'
31. Type of D~ge or Loss (Check All Appropriate Boxes): (1)
Limited

/ A.
B.
C•
D.
Breakage of Glass
Theft of Merchandise
Smoke Damage
Water Damage

1/ r

/ E.
F.
Fire Damage
Other - Specify: 0 £p .S e Le~
/
32~rese~t Condition of Premises: L:7 D~lished; L:7 No Repairs Undertaken;
~ ~ L:7 Repairs Underway; Li7 Repairs Completed.
33. Present Status of Business: L:7 Closed; L:7 In Partial Operation; Full Operation; /Zfin
L:7 Moved Business or Establishment Operations to Another Location.
34. If the bu~ss or establishment operations were moved to another location, please indicate
where? LZ7In the Same Neighborhood; L:7
Elsewhere in D.C.; Outside D.C. L:7
~ Extent of Financial Loss (Please Estimate, If Necessar,y):
C7 (1)
Stock or Inventory Fixtures & Equipment
(2)

lue Prior to Civil Disturbance $ 1/(,D._ $ ~foO._ $·-~~~


B. a~e of Damage or Loss from
~'Civil Disturbance $
.- $ £CO .co $ ,.cO . oe
ount of Insurance Coverage NDIJi. $ A)Q N-•
surance Compensation Received
Up to Now
$
$
,, .- $ ,,
$
$
NtrnC!
NtnJe ._
-4-

Has !J'y( insurance on this establishment been changed sinr#~e civil disturbance?
M Cancelled; D Reduced; D Other - Specify:~;,..(r---.!114!;2(L
~~------------
37. Futur~~lans (Even Though Plans May Be Tentative):
ell Business or Establishment
~ Remain Open for Business at Same Location
Reopen ror 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.
Simply Go Out of Business
Other - Specify=----------------------------------------------------------------
38. What
side

Check the appropriate box below if you wish information ab ut any of the following:
Small Business Administration programs
Assistance in finding a new location
Retraining or employment assi tance 1/
Other assistance, such as lega or account rM(Cl f

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: