Rootstown Township Confidential Income Survey

Portage County, Ohio

Information provided by this survey is confidential and will only be used 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 a written request made by authorized persons in conformance with the Ohio Revised Code.

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

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

8 or more