Mantua Village Confidential Income Survey

Portage County, Ohio

The information provided by the completion of this survey is confidential and will be used only by the local government staff administering this program and state agency personnel responsible for program oversight. Information and records will only be released as permitted by State and Federal law, pursuant to written request made by authorized persons in conformance with the Ohio Revised Code.

Question Title

* 1. What is the address where you currently live?

Question Title

* 2. How many members are in your household (include yourself, spouse, children, etc)?

8 or more