1971 Census of Canada

ED No. ____
EA No. ____
HHLD No. ____

Address of exact location:

Street and No. or Lot and concession ____
City, town, village, municipality ____
(Province) ____

Complete your questionnaire on Tuesday, June 1.

Important:
To foreign residents:
If all members of this household are:

Persons temporarily visiting Canada; or
Students whose usual residence is outside Canada; or
Government representatives or members of the Armed Forces of another country and their families;

Fill this circle and do not complete this questionnaire.
To temporary residents
If all members of this household are:
Staying here temporarily; and have a usual home elsewhere in Canada;
Fill this circle and complete Questions 10 and H9 on page 3.

To make certain that every Canadian resident is counted in the census (and that no one is counted more than once) the following guide should be used when deciding who should or should not be included on this form:
Include:

Everyone who usually lives here; members of the household who are temporarily away (e.g., students at school or university); persons staying or visiting here who have no other usual home; persons who normally live here but have been in an institution (e.g., hospital, sanatorium) for a period of less than six months); lodgers, boarders, servants, hired hands and other non-relatives living here; infants born before midnight, May 31, 1971; unmarried persons who have a home elsewhere but who stay in this household most of the week while working.

Do not include:

Infants born after midnight, May 31, 1971; persons away in an institution (e.g. hospital, sanatorium) if they have been there for a period of six months or more;
Persons away from home in the permanent Armed Forces; foreign government representatives or members of the Armed Forces of another country and members of their families who are not citizens of Canada; unmarried sons or daughters who live elsewhere most of the week while working, even if they return home on weekends.

Please start with Question 1 by listing names.
1) Print the names of usual residents of this dwelling on June 1, 1971.

a. Present in this dwelling
b. Temporarily away

Include persons with no other home.
For definitions and order of listing see Instruction Booklet.

Last name ____
First name ____
Initial ____

2. Relationship to head of household

The head of household is the husband rather than the wife; the parent where there is one parent only with unmarried children, or any member of a group sharing a dwelling equally.
Fill one circle only.
[] Head of household
[] Wife of head
[] Son or daughter of head
[] Father or mother
[] Brother or sister
[] Son-in-law /daughter-in-law
[] Father-in-law/mother-in-law
[] Brother-in-law/sister-in-law
[] Grandchild
[] Lodger
[] Lodger's wife
[] Lodger's child
[] Nephew or nice
[] Other, specify as uncle, aunt, employee, employee's wife, employee's child, partner ____

3. Sex

Fill one circle only.
[] Male
[] Female

4. Marital status

Fill one circle only.
[] Single (never married)
[] Now married
[] Widowed
[] Divorced
[] Separated

5. Mother tongue

Language first spoken and still understood
Fill one circle only
[] English
[] French
[] German
[] Italian
[] Other (specify) ____

6. Month and year of birth

Month

[] January to May
[] June to December

Year of birth

Decade
Fill one circle only
[] 186_
[] 187_
[] 188_
[] 189_
[] 190_
[] 191_
[] 192_
[] 193_
[] 194_
[] 195_
[] 196_
[] 197_

Actual year

Fill one circle only
[] 0
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8
[] 9

7. Are there more than 7 persons in this household?

[] Yes: List 7 persons only on this form. Use the additional form provided to list other household members.
[] No

8. Is there anyone left out of question 1 because you were not sure whether they should be listed?

[] Yes
[] No
For example, a lodger who also has another home, a new baby still in the hospital, or a former occupant of this household who has become a patient in a hospital or sanatorium within the past six months.

If "Yes", write name(s) here and the reason: ________

9. Is there anyone listed in question 1 who is away from home now?

[] Yes
[] No: for example, on a vacation, attending university or in a hospital.

If "yes", write name(s) and reason this person is away. ________

10. How many visitors or other persons who have a usual home elsewhere in Canada stayed here on June 1?

[] None
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8
[] 9
[] 10 or more

H1 to H9 should be answered by the head of the household.
Note that the dwelling refers to the living quarters occupied by this household. See definition in instruction booklet.

H1. Is this dwelling:

[] Owned or being bought by you (or a member of this household)?
[] Rented (even if no cash rent is paid to the landlord)?

H2. How do you enter your living quarters?

[] By a separate private entrance from outside
[] Through a common hall or passageway
[] Through someone else's living quarters

H3. Is this dwelling a

See drawings of types of dwellings in instruction booklet.
[] Single house (not attached to any other building and containing one dwelling only)?
[] Single house attached to another building at ground level (such as a store, etc.) but separated from it by a common wall running from ground to roof?
[] Semi-detached or double house (one of two dwellings joined side by side, not attached to any other building)?
[] Row house (one of three or more houses joined side by side, such as a town house, garden home, terrace house, etc)?
[] Duplex (one of two dwellings, one above the other, not attached to any other building and each having a separate entrance)?
[] Apartment (in an apartment building in a house that has been converted into apartments or in a non-residential building)?
[] Mobile (such as a trailer or houseboat)?

H4. How many dwellings are there in this building?

[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8-9
[] 10-24
[] 25-49
[] 50-99
[] 100 or more

H5. How many rooms are there in this dwelling?

Include kitchen, bedrooms, and furnished rooms in attic or basement. Do not count bathrooms, halls, vestibules, and rooms used solely for business purposes.
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8
[] 9
[] 10
[] 11
[] 12 or more

H6. Is there piped running water in this dwelling?

[] Yes, both hot and cold
[] Yes, cold only
[] No

H7. Does this household have the use of an installed bath or shower in this building?

[] Yes, for this household only
[] Yes, but also used by another household
[] No

H8. Does this household have the use of a flush toilet in this building?

[] Yes, one for this household only
[] Yes, two or more for this household only
[] Yes, but also used by another household
[] No

H9. At what telephone number can this household be reached?

[] _____
[] No telephone

Remember that

A household is the person, or a group of persons, occupying one dwelling.
A dwelling is a separate set of living quarters with a private entrance from outside or from a common hallway or stairway inside the building.
If you have to pass through anyone else's living quarters to reach your own, yours is not a separate dwelling

H10 to H20 should preferably be answered by the head of the household.

H10. When was this building originally constructed?

Mark the period in which the building was constructed, not the time of any later remodeling, additions, or conversions.
[] 1971
[] 1970
[] 1969
[] 1966-68
[] 1961-65
[] 1951-60
[] 1946-50
[] 1921-45
[] 1920 or before

H11. How long have you lived in this dwelling?

[] Less than one year
[] 1 to 2 years
[] 3 to 5 years
[] 6 to 10 years
[] More than 10 years

H12. Did you own or rent your previous dwelling in Canada?

[] Owned
[] Rented
[] Living in no other dwelling in Canada
[] Not head of household in previous dwelling

H13. How many bedrooms are there in your present dwelling?

[] None
[] 1
[] 2
[] 3
[] 4
[] 5 or more

H14. Is your source of water supply from:

[] Municipal or private company system?
[] A well on your property?
[] Other source (spring, river, etc.)

H15. What is the method of sewage disposal for this dwelling?

[] Connection to public sewer
[] Septic tank
[] Other (cesspool, pit, etc.)

H16. What is the principal type of heating equipment for this dwelling?

This question refers to the physical heating equipment regardless of the fuel used.
[] Steam or hot water furnace
[] Hot air furnace
[] Installed electric heating system
[] Heating stove, cook stove, space heater
[] Other (fire place, etc.)

H17. Which fuel is used for:

Fill one circle in each column.

House heating

[] Oil or other liquid fuel
[] Piped gas
[] Bottled gas
[] Electricity
[] Coal or coke
[] Wood
[] Other
[] No fuel used

Cooking

[] Oil or other liquid fuel
[] Piped gas
[] Bottled gas
[] Electricity
[] Coal or coke
[] Wood
[] Other
[] No fuel used

Water heating

[] Oil or other liquid fuel
[] Piped gas
[] Bottled gas
[] Electricity
[] Coal or coke
[] Wood
[] Other
[] No fuel used

H18. How many automobiles are available for personal use by members of this household?

Include leased or company cars regularly kept at home for some personal use.
[] None
[] 1
[] 2
[] 3 or more

H19. Does any member of this household own a vacation home?

Include only those used mainly for personal use. Do not include trailers or any other mobile homes.
[] No vacation home
[] One vacation home
[] Two or more vacation home

H20. Do you have the following items in your living quarters?

a. Refrigerator (electric or gas)

[] Yes
[] No

b. Home freezer (separate from your refrigerator)

[] Yes
[] No

c. Electric dishwasher

[] Yes
[] No

d. Automatic clothes dryer

[] Yes
[] No

e. Television set(s)

Black and white

[] Yes
[] No

Color

[] Yes
[] No

All household heads (owners or tenants) should answer the questions below which apply to this dwelling unless the head is a farm operator living on the farm which he operates. Farm operators turn directly to page 6.

H21. Is this dwelling

[] Owned
[] Rented

H22. If you were selling this dwelling now, for how much would you expect to sell it?

[] Under $3,000
[] $3,000 -- 7,499
[] $7,500 -- 12,499
[] $12,500 -- 17,499
[] $17,500 -- 22,499
[] $22,500 -- 27,499
[] $27,500 -- 32,499
[] $32,500 -- 37,499
[] $32,500 -- 37,499
[] $37,500 -- 42,499
[] $42,500 -- 52,499
[] $52,500 -- 62,499
[] $ 62,500 or more

H23. Is there a mortgage on this dwelling?

[] Yes, first only
[] Yes, more than one.
[] No: Skip to H25.

H24. Who holds the first mortgage?

[Question H24 is asked of households that have mortgage on their dwelling, per question H23.]
[] Bank or insurance loan, trust or mortgage company
[] Government (Federal, Provincial or Municipal)
[] Private individual
[] Other (Credit Union, etc.)

H25. Is there a garage on this property? (Do not include carports)

[] Yes
[] No

H26. Are any of the following included in your rent?

a. Furniture or furnishing

[] Yes
[] No

b. Air conditioning

[] Yes
[] No

c. Refrigerator

[] Yes
[] No

d. Stove(s)

[] Yes
[] No

e. Off-street parking (inside)

[] Yes
[] No

f. Off-street parking (outside)

[] Yes
[] No

H27. What total cash rent do you pay for this dwelling?

Deduct value of rent for rooms used exclusively for business or professional purposes.
Fill circle and enter amount (Report dollars only)
[] $ ____ per month
[] $ ____ per week
[] No cash rent

H28. In addition to your rent, what is your average payment for:

a. Water? (monthly)

[] $ ____
[] None

b. Electricity? (monthly)

[] $ ____
[] None

c. Gas? (monthly)

[] $ ____
[] None

d. Oil, coal, wood or kerosene? (yearly)

[] $ ____
[] None

H29. Do you pay a reduced rent for one of the following reasons?

[] Government subsidized housing (include Federal, Provincial and Municipal projects as well as Department of National Defense and limited dividend projects)
[] Services to landlord
[] Other reason (company housing, etc.)
[] No reduced rent

[Person questionnaire]
Name of person ____

11. Where were you born?

If born in Canada, mark the province then skip to question 13.
[] Nfid.
[] N.S.
[] Que.
[] Man
[] Atla
[] Yukon
[] P.E.I.
[] N.B.
[] Ont.
[] Sask.
[] B.C.
[] N.W.T.
Otherwise, mark country according to present boundaries
[] U.K.
[] Germany
[] Italy
[] Poland
[] Rep. of Ireland
[] U.S.A.

12. If born outside Canada, in which period did you first immigrate to Canada?

[] Before 1931
[] 1931-1945
[] 1946-1950
[] 1951-1955
[] 1956-1960
[] 1961-1964
[] 1965
[] 1966
[] 1967-68
[] 1969
[] 1970
[] 1971

13. Were your parents born in Canada?

[] Both
[] Neither
[] Mother only
[] Father only

14. Of what country are you a citizen?

[] Canada
[] U.S.A.
[] U.K.
[] Other, write here ____

15. To what ethnic or cultural group did you or our ancestor (on the male side) belong on coming to this continent?

[] English
[] French
[] German
[] Irish
[] Italian
[] Jewish
[] Native Indian

Band ____

[] Native Indian

Not band ____

[] Netherlands
[] Norwegian
[] Polish
[] Scottish
[] Ukrainian
[] Other, write here ____

16. What is your religion?

[] Anglican
[] Baptist
[] Greek Orthodox
[] Jewish
[] Lutheran
[] Mennonite
[] Pentecostal
[] Presbyterian
[] Roman Catholic
[] Salvation Army
[] Ukrainian Catholic
[] United Church
[] No religion
[] Other, write here ____

17. What language do you most often speak at home now?

[] English
[] French
[] German
[] Indian
[] Italian
[] Magyar
[] Netherlands
[] Polish
[] Ukrainian
[] Yiddish
[] Other, write here ____

18. Can you speak English or French well enough to conduct a conversation (See instruction booklet.)

[] English only
[] French only
[] Both English and French
[] Neither English nor French

19. Have you attended school or university since last September?

[] Yes, full time
[] Yes, part time: day or evening
[] No

20. What is the highest grade or year of elementary or secondary school you ever attended? (See instruction booklet).

[] No schooling
[] Kindergarten
[] Elementary or secondary (grade or year)

[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8
[] 9
[] 10
[] 11
[] 12
[] 13

21. Are you 15 years of age or older (i.e. born before June 1, 1956)?

[] No: end here for this person
[] Yes: continue below.

[Questions 22-40 were asked of persons age 15+, per question 21.]

22. Where did you attend your highest grade of elementary or secondary school?

[] This province
[] Other province (specify) ____
[] Outside Canada
[] No schooling

23. How many years of schooling have you had since secondary school?

[] University

[] None
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6

[] Other (See instruction booklet)

[] None
[] 1
[] 2
[] 3

24. Do you have a university degree, certificate or diploma?

Mark highest academic qualification.
[] Non university degree, certificate or diploma
[] Yes, a university certificate or diploma (below Bachelor level
[] Yes, Bachelor degree
[] Yes, first professional degree
[] Yes, a Master's or equivalent or earned Doctorate (e.g. Ph.D., Ed. D.)

25. Have you ever completed a full time vocational course of three months or longer?

Do not include university or high school courses.
[] Yes, apprenticeship course
[] Yes, other full time vocational
[] No: go to question 26.

[If it is apprenticeship course or full time vocational]
a) Describe course or apprenticeship of longest duration ________
(e.g. auto mechanic, drafting, ceremonial art, X-ray technician, accounting, barbering)

b) How long was this course or apprenticeship?

[] 3-5 months
[] 6-12 months
[] 1-2 years
[] 2-3 years
[] More than 3 years

c) When did you complete this course or apprenticeship?

[] Before 1946
[] 1946-1955
[] 1956-1960
[] 1961-1965
[] 1966-1968
[] 1969-1971

26. Where did you live 5 years ago on June 1, 1966?

[] Same dwelling: skip to question 28.
[] Same city, town, village or municipality (not same dwelling)
[] Outside of Canada
[] Different city, town, village or municipality in Canada,
give its name

____ City, town, village, municipality, etc.
____ County
____ Province

Important: If outside city or town limit, specify name of suburban municipality and not of city or town.

27. How many times have you moved from one Canadian city, town, village or municipality to another since June 1, 1966?

[Question 27 was asked of persons 15+ whose dwelling five years ago was different from the present one.]
Count moving away and returning to the same place as 2 moves.
[] None
[] 1
[] 2
[] 3
[] 4
[] 5 or more

28. What was the date of your first marriage?

[Question 28 was asked of persons ever married.]
Mark circles for month, decade and year
Month

[] January
[] February
[] March
[] April
[] May
[] June
[] July
[] August
[] September
[] October
[] November
[] December

Decade

[] 188_
[] 189_
[] 190_
[] 191_
[] 192_
[] 193_
[] 194_
[] 195_
[] 196_
[] 197_

Year

[] 0
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8
[] 9

29. How many babies have you had not counting stillbirths?

[Question 29 was asked of women ever married.]
[] None
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8
[] 9
[] 10
[] 11
[] 12
[] 13
[] 14

30. Did you have any wartime service in the active military forces of Canada or allied countries?

[Question 30 was asked of men 35 years of age or over.]
[] Yes, in World War I or earlier wars
[] Yes, in World War II or in Korea
[] No wartime service

31. a. How many hours did you work for pay or profit last week?

Include all jobs and overtime.
[] None
[] 1-19
[] 20 or more

b. Last week, how many hours did you help without pay in the operation of a family business or a farm?

Do not include housework in own home.
[] None
[] 1-19
[] 20 or more

c. Did you look for work last week?

For example, contact a Canada Manpower Centre, check with employers, place or answer newspaper ads, etc.
[] Yes
[] No

d. Last week did you have a job from which you were on temporary lay-off?

[] Yes
[] No

e. Last week, did you have a job or business from which you were absent because of illness, vacation, strike, training courses, etc.?

[] Yes
[] No

32. When did you last work at all, even for a few days?

[] In 1971
[] In 1970
[] Before 1970: skip to question 40
[] Never worked: skip to question 40

Questions 33-38 refer to your job or business last week. If none, answer for your job of longest duration since January 1, 1970.
[Questions 33-38 were asked of persons 15+ who worked in 1970 or 1971, per question 32.]

33. How many hours do you usually work each week?

[] 1-19
[] 20-29
[] 30-34
[] 35-39
[] 40-44
[] 45-49
[] 50 or more

34. For whom did you work? Please print:

Name of firm, government agency, etc. ____
Department, branch, division, or section ____

35. Industry: What kind of business, industry or service was this?

Give full description e.g. paper-box manufacturing, road construction, retail shoe store ____

36. Occupation

a. What kind of work were you doing? ____

e.g., selling shoes, civil engineering, motor vehicle repairing, metal machining, clerical work.

b. What were your most important activities or duties? ____

e.g. fitting shoes, designing bridges, auto body work, posting invoices.

c. What was your job title? ____

e.g. manager of shoe department, civil engineer, auto body repairman, invoice clerk.

37. In this occupation were you mainly:

[] Working for wages, salary, tips or commission?
[] Working without pay in a family business or farm?
[] Self-employed without paid help?

Was this farm or business incorporated?
[] Yes
[] No

[] Self-employed with paid help?

Was this farm or business incorporated?
[] Yes
[] No

38. Where do you usually work?

Give this information for job described above. If no usual place of work, see instruction booklet.
Number ____
Street ____
City, town, village or municipality ____
County ____
Province ____

[] At home
[] Outside Canada

39. a. In how many weeks did you work during 1970?

Include weeks worked part-time, leave with pay and weeks of self-employment
[] Did not work during 1970
[] 1-13
[] 14-26
[] 27-39
[] 40-48
[] 49-52

b. Was this work mainly full-time or part-time?

[] Full-time
[] Part-time

40. Income for 1970 (State in dollars only)

a. During 1970 what were your total wages and salaries, commissions, bonuses, tips, etc? (before any deductions)

[] Amount $____
[] None

b. During 1970 what was your net income from self-employment or operating your own non-farm business or professional practice?

State total business income less expenses of operation.
If lost money, give amount and write "Loss"
[] Amount $____
[] None

c. During 1970 what was your net income from operating a farm on your own account or in partnership?

State total farm income less expenses of operation. If loss money, give amount and write "Loss"
[] Amount $____
[] None

d. During 1970 how much income did you receive from

1. Family and youth allowances?

[] Amount $____
[] None

2. Government old age pensions, Canada pensions and Quebec pensions?

[] Amount $____
[] None

3. Other government income? (e.g. veteran's pensions and allowances)

[] Amount $____
[] None

4. Retirement pensions from previous employment?

[] Amount $____
[] None

5. Bond and deposit interest and dividends?

[] Amount $____
[] None

6. Other investment income? (e.g. net rents)

[] Amount $____
[] None

7. Other income? (e.g. alimony)

[] Amount $____
[] None

e. During 1970 what was your total income? (a+b+c+d)

[] Amount $____
[] None

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