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20 A: lalF- 7 Nw. —~ aro (pe) ideal ove Loe zg “\ghington Civil Disorder Survey Tracking Form Survey File Wo, O06 1/7 PR = Survey Staff Person with Primary Responsibility. LF wosiness oR [TJ Property SR = Survey Staff Person with Seoondary Responsibility. C&AC ~ Completeness and Accuracy Check. 1. “Fite Assigned 1 LT Questionnaire Non-Response File: 2, ‘Tracking Form ONLY Received 3. Further Identification end Call-Packs: A. Started B, Questionnaire Re-miling Request Made to CONTROL C. Contact Notes:, > Continued Over. LG Returned Questionmire File: 4, Questionnaire Received OR If Filled Out by PR, Reported to CONTROL 5. Questionnaire Emmined: ‘Identification Checked; If Incorrect, Reported to CONTROL CT Wo Damage or Loss; File Returned to CONTROL & Terminated oR “LF bas or Loss; Reported to CONTROL for Agency Inf, Form Questionnaire Complete; No Call-Backs ca oR wad pro p+ es “~ [J Questionnaire Taepiatert CP dO ES 6, Cali-Racks: A. Started B, Contact Kotes:, > Continued Over. C, Gali-iecks ani Questionnaire Completed % fications of Other Affected Businesses or Properties Found: Ho oR Reported to CONTROL 8, Completed Questionnaire Referred To: ” [." f.”"” 9. Questionnaire Received for CSAC CAAC Completed; Questionnaire Returned to PR 10, Questionnaire Received ‘Additional Work, If Any, and Questionnaire Completed 11. Agency Informtion Form Completed: ‘Location Information Recorded ‘DUC BD Informtion Recorded S0C, SEC. Informtion Recorded 12, EDP Coding Sheet Completed 13, Entire File Referred T0:. SR for C&aC A, Entire Pile Received for C&AC C&AC Completed; Entire File Returned to PR 15. Entire File Received Additional Work, If Any, and File Certified Completed and Forewarded to CONTROL 16, Entire File Received: Entry Made on Control Sheets EDP Coding Sheet Forewarded for EDP All Other Materials Filed 3 SSSag3 1 aI RES || BP BESSSS 8 8B BS PR PR SR sR PR mR : 88 3 8 383 BOS Control Control Control eee Conteh // 88 Check by PR: 1. [J Tracking Form; 2. [J] acstionnsire; ‘Agency Information Form; and 4, [J EDP Coding Sheet. ip hs Le & District of Columbia Y Civil Disturbance Report Me. purivess information Survey a Please complete one of these forms for each business establishment you are associated with that sustained any physical danage or theft, however minor, during the recent civil disturbance wu are associated with sustained no physical ie tne District of Golunbia. If an establishment you are associated stained no physi damage or theft at all, please complete Items 1, 2, and 3 only and return the form. A business establishment 1s defined as any commercial enterprise or unit at one address. If you need more Hees amege call Mise Geraldine Johnson, D.C+ Redevelopaent Land Agency, telephone: 382-6950+ uainoss tourntamant: 1. tas PERSONALITY STUOIO 7 THeP y TT = 2e Address: bl & us AM US 3. Phone: Co -5- 635% bape Firat Danage or Theft Ocourreas__+° HY (ES 3< Date(s) ‘Subsequent Danages or Thefts Oceurred, If Ang: // 5 HE 5G RA WEBEL | Bushrigas Omer (or Principal Officer): 6+ Manes Ge he C7 weer 30; LJ 30 +0 503 LY over 50. a. racer GP wnite; LY Negros L7 other. 5 ene astreoe:_ 1337 7's PA NW Phone 2 roagge or otabiisnnent (If Ditterent from Omer): 30. Names___9 4 AM a. Ages LJ Under 30; 7 30 to 50; 7 Over 50. 12. Races [J White; [7 Negros 7 Other. ———— Phonet 5 SUEF ah eee _& tate etabhtphment as Located ot Tha aadrene On Thee Inmediate Neighborhood: After 1965; / 1960 to 19655 1950 to 1959; £7 1940 to 19495 Before 1940. 15.Aenezghip of Business: [J Single Proprietorship; [7 Partnerships [7 Corporation; "77 Other ~ Speeitys es) _ 2 Wore Than 0 Percent Tees Than 50 Percent of Dollar Value of _of Dollar Value of Sales Sales 16, Type of Establishment Operations (Check AlL Appropriate Boxes): A. Manufacturing ‘Wholesale Trade 1 Af Retail Trade Be Service /B. Warehousing P, Other ~ Specify: 17. Specify Principal Product or Services C-ters Acnums Frames PHeTes ve / 7 Vv M’,. prior to the civit/Aisturbance, 41a the business: (5 Om or £7 RINT the premises for reser teattjengent? If the prentece. were rented, Now much rent was paid? i 19. Total Annual Rent: $_ oe 20. Total Floor Area: 2500 Square Fee Bit Anmuat Rent, Per Square Foot? ¥ fises wore rented for this establishment, has there been any change up to now in 1 status of the establishment as a result of the civil disturbance: Wo Change Business or Establishment Sold Lease Terminated Rent Increased and Hstablishment 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: 22. If the pr Foxinate Gross Sales of This Establishnent During Last tax Year: §_///O00 Jos eee he Appfoximate Taxable Income from This Establishment During Last Tax Year: §. Beier 25. Trade Area of This Bstablishnent Before Civil Disturbance (Check ALL Appropriate Boxes): Primary Market Secondary _Market(s) Wore Than 50 Percent Less Than 50 Percent of Total Dollar of Total Dollar ; Tapes rao Sates ee Ee cee Waheed eR ieee te C. All of District of Columbia D/ Parts or All of Washington Metropolitan Are (, Larger Region Including Wash. Metrop. Area Ay Inmédiate Neighborhood (Within 10 Blocks) B. Larger Section of District of Columbia 26\\ Afproxinate/ Number of Square Feet of Floer Space Now Occupied ty This Establishtent: 27. Employment of Establishment During Full Work Week Before Civil Disturbance: Number of Persons White Tegro ‘Other Total Fale Fomalc ele Fonale Gale Female ale Female ‘he Pata and Unpaid Family Works . a + Pa inp jorkers 2 & Wo oe ‘Including Owner) Doe tte Ee B. Part-tine Paid Snployees (Less Phan 10 Hours) a ee Ame Paid Employees (10 fours or More)s as Managerial & Professional ‘b, Clerical c1 Sales a. Craftenen & Other Skilled es Drivers & Other Semi~skilled Ss Laborers & Other Unskilled iL H || || H HCH Hitt Hitt tH ( KY CHILI ie E C C, Pull-time Subtotal ( ( i ESTABLISHMENT TOTAL “As, mpromment of Bsfablisiment During Most Recent, Full Work Week: Nunber_of Persons alhite Negro _Other ___—_Total Female ale Female fle Femle ale Female (2) As Paid and Unpaid Fantly Workers (Including Ovaer) Se a te = a oa B. Part-time Paid Employees (Less g Manageciel'@ Profcestonaligg? <2 ce Se eee ’b. Clerical = c. Sales =e ee a. Graftenen & Other Sted = g- Drivers & Other Soxf-akitea —— IT > I TT f. Laborers & Other Unskilled — eee Cs Fubl-tine Subtotal (-_) (__) (__) (_) (_) (_) (0) (0) [ DAESTABLISINCSNT TOTAL é L + ak 29. & 30. or Loss (Check All Appropriate Boxes): 31. type ant A, Sreakage of Glass A [82 Tett of Merchandise / \gf Cs Smoke Damage / Dy Water Damage E. Fire Damage F. Other ~ Specify: / | | of Repairs Underway} ie ‘caploysea/p thie Aetablistment were transferred to other locations of your Yusiness, Af any/xe a reslt of damage fron the civil dloturbance? persons Z. How many omployeés of this establishment, if any, did your firm help find jobs with other businesses becglise of/damage from the civil disturbance? ¢ Persons ol) pei — (Barre Tinited Extensive fd Prcomr. Cats ile 7 ape 7 Repairs Coapleted. Prosent Statugof Business: [7 Closed; J’ In Partial Operations [7 In Full Operation; Moved Business or Establishment Operations to Another Location. If the where? he ‘the Same Neighborhood; 35+ Extent of Financial Loss (Please Estimate, If Necessary): L ee Sock or Inventory Fixtures & Gquipment A By Value Prior to Civil Disturbance Value of Damage or Loss from Civil Disturbance Amount of Insurance Coverage Insurance Compensation Received Up to Now TOI. ¢ Fn a Ci De 15 or establishment operations were moved to another location, please indicate Elsewhere in D.C. Outside D.C. 2. ee sffe08 a SES jieetooe, 36. ligS the insurance on this establishment been changed since the civil disturbance? PF cateclied; £f Reduced; Z/ Other ~ Speeitys Viet Ueda & 37+ Fyturg Plans (Even Though Plans May Be Tentative): Sell Business or tstablishnent Romain Open for Business at Sane. Location Reopen for Bisiness at Sane Location Relocate Business or Establishment Elsewhere in Same Neighborhood Helooste Business or Establishment Outelde of Fomer Reighberhoed, But Inside D.C. Relocate Business or Establishment Outeide of D.C Simply Go Out of Business : ~ wie Other - specttys Veep ( Wik fe $+/e TOK AGEN KLIN STORE 38. What reasons are the most important in selecting one of the above alternatives over the others for you, your business or establishment? (Please explain and use the reverse side of this page, if needed.) CLU A (sh OC A AVE PLANS 70 SAL Ai tt eile = Dee Te f Hage Mere eb 39»/ Check the appropriate box below if you wish information about any of the followings : Small Business Adninistration programs Assistance in finding a new location Retraining or employment assistance Other assistance, such as legal or accounting ~ Specifys, 10. phis form vag completed by ~ Signatures, Cand PULA pte Aine (o/ LF mies GO - + Ceuner Do Not Write Below This Line l