NAME AND SURNAME

RELATIONSHIPto Head ofFamily,or position inInstitution

AGE(last Birthday)and SEX.

PARTICULARS AS TO MARRIAGE.

PROFESSION OR OCCUPATIONof Persons aged ten years and upwards.

BIRTHPLACEof every person.

NATIONALITYof every personborn in aForeign Country.

INFIRMITY.

State whether“Head” or“Wife,” “Son,”“Daughter,” or other Relative,“Visitor,”“Boarder,” or“Servant,”

For Infantsunder one yearstate the agein months as“under one month,”“one month,”etc.

Write“Single,”“Married,”“Widower,”or “Widow,”opposite thenames ofall personsaged 15 yearsand upwards.

State, for each Married Womanentered on this Schedule, thenumber of:–

Personal Occupation.

Industry or Service withwhich worker is connected.

Whether Employer,Worker,or Working onOwn Account.

WhetherWorking atHome.

• If born in the United King-dom, write the name of theCounty, and Town or Parish.
• If born in any other part ofthe British Empire- writethe name of the Dependency,Colony, etc., and of theProvince or State.
• If born in a Foreign Country,write the name of the Country.
• If born at sea, write “At Sea.”

NOTE.—In the case of personsborn elsewhere than in England orWales- state whether “Resident” or“Visitor” in this Country.

State whether:—

• British sub-ject by parent-age.”
• NaturalisedBritish sub-ject,”givingyear of natu-ralisation.

• If of foreignnationality,state whether“French,”“German,”“Russian,”etc.

If any personincluded in thisSchedule is:—

• TotallyDeaf,” or “Deafand Dumb”
• “TotallyBlind,”
• “Lunatic,”
• “Imbecile,”or “Feeble-minded,”

state the infirmityopposite that per-son's name, andthe age at whichhe or she becameafflicted.

Com-pletedyears thepresentMarriagehaslasted.If less thanone yearwrite“underone”

Children born alive topresent Marriage.(If no children bornalive write“None” in Column 7).

The reply should show the precise branch ofProfession, Trade, Manufacture, &c.

If engaged in any Trade or Manufacture, theparticular kind of work done, and the Articlemade or Material worked or dealt in shouldbe clearly indicated.

(See Instructions 1 to 8 and exaples on backof Schedule.

This question should gener-ally be answered by statingthe business carried on bythe employer. If this isclearly shown in Col. 10the question need not beanswered here.No entry needed for Domestic Ser-vants in private employment.If employed by a public body(Government, Municipal, etc.)state what body.

(See Instruction 9 and Exam-ples on back of Schedule.)

Write opposite the name of each personengaged in anyTrade or Industry,(1) “Employer”(That is employingpersons other thanDomestic Servants),(2) “Worker” (thatis working for anemployer)- or(3) “Own Account”(that is neitheremploying othersnor working for atrade employer).

AgesofMales

AgesofFemales

TotalChildrenBornAlive.

ChildrenStillLiving.

ChildrenwhohaveDied.

1

2

3

5

10

11

12

13

14

15

16