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r i L i x o u n j , i ii v i v u / - i n i s v^ u ixi i i v n j Form 1 STATISTICS FOR TH E Y E A R 1917 Collected by Robt. F. Cole Labor Commissioner for the State of Nevada P E N A L T Y FOE F A IL U R E TO F U R N IS H D E T A IL S A N D STATISTIC S Chapter 203, Statutes o f Nevada, approved March 24, 1915 “ Sec. 11. Said Labor Commissioner shall prepare form s and blanks fo r the purpose o f gathering the information and statistics required by this Act, and may require any person, firm, or corporation to give the information and statistical detail designated in such forms, and any person, firm, or corporation who shall refuse to furnish such detail and statistics in the form required, shall be guilty o f a misdemeanor, and upon conviction thereof may be fined not less than one hundred dollars nor more than five hundred dollars.” C E R T IF IC A T IO N OF STATISTIC S This is to certify that I have read the foregoing requirements o f the law and the special instructions contained on the face o f this form, and in accordance therewith I have prepared, or caused to be prepared, the following statistical information, which is true to the best o f my knowledge and belief. Signed a t .................... ....... .......... ............................. Name...................... ............................ ......................... t h i s . . . . ....... day o f__•.... ............................. , ___ .___ T itle....... .......... .-............ ................................... IM P O R T A N T IN STR U C TIO N S The instructions on the last page o f this form must be read before attempting to fill out the following blanks and observed fu lly in recording the detail and statistics which are required. CARD IN D E X CO U NTY CODE F IL E NO. Name of Firm Kind o f Business Office Address Official in Charge Title of Official O R G A N IZ A TIO N A N D E X T E N T OF BUSINESS 1— Organized in the year.................. + 2— A verage number o f employees in service during the year 1917............................................................... 3— Highest number o f employees in service during the year 1917 is shown on the pay-rolls fo r the month o f ...................................................................................... to b e .................. ........ — .... ............................................... 4— Lowest number o f employees in service during the year 1917 is shown on the pay-rolls fo r the month o f ..................................................................... to be ? ..................................................... ..................——... Name, sex, age, nationality, address, occupation, daily wage, hours worked per day, wages for month of November, 1917, and days worked per annum of employees, see inside pages.