Republic of Costa Rica
General Directorate of Statistics and Censuses

VI National Population and Housing Census
April 1st, 1963

Form CPV

Identification

____ Province
____ Canton
____ District
____ Agricultural Region number
____ Zone number
____ Section number
____ Segment number

[] Urban
[] Rural

____ Census household number (visit order)
____ Institution (name)
____ Neighborhood or hamlet (caserío)
____ Avenues (numbers)
____ Streets (names)
____ Highway, route, etc.

Housing Census

1. Dwelling type

(mark only one box)

[] 1 Private
[] 2 Collective

2. Predominant material in the walls

(mark only one box)

[] 1 Wood
[] 2 Concrete
[] 3 Metal sheet
[] 4 Adobe and cane with earth covered with a cement cap (bahareque)
[] 9 Other (specify) ____

3. Predominant material in the floors

(mark only one box)

[] 1 Wood
[] 2 Tile
[] 3 Brick
[] 4 Mosaic or concrete
[] 9 Other (specify) ____

4. Predominant material in the roof

(mark only one box)

[] 1 Clay tiles
[] 2 Metal sheet (zinc, aluminum, etc.)
[] 9 Other (specify) ____

5. Condition of the dwelling

[] 1 Good
[] 2 Fair
[] 3 Poor

6. Water source

By pipe (mark one box in each case, a, b, and c)

a)
[] Public system
[] Private system
b)
[] Inside the dwelling
[] Outside of the dwelling
c)
[] For this dwelling only
[] For this and other dwellings

By other means

[] 8 Well
[] 9 Other (specify) ____

[] X Does not have

8. Sewer facilities

(mark only one box)

[] 1-2 Sewer
[] 3-4 Septic tank
[] 5-6 Concrete Cesspool (Pozo negro de planchet)
[] 7-8 Wooden Cesspool (Pozo negro de madera)
[] 9-0 Other
[] 11 Does not have

9. Use of the toilet facilities

(mark only one box)

[] For this dwelling only
[] For this and other dwellings

10. Electric energy

(mark only one box)

[] 1 For lighting only
[] 2 For lighting and other uses
[] X Does not have

11. Fuel used for cooking

(Note the primary one)

____
(Electricity, gas, kerosene (canfín), wood, charcoal, etc.)

12. Appliances in the dwelling

(mark a box on each line)

Radio

[] 1 Has
[] 4 Does not have

Electric iron

[] 2 Has
[] 3 Does not have

Code ____

Electric cook stove

[] 1 Has
[] 4 Does not have

Vacuum cleaner

[] 2 Has
[] 3 Does not have

Code ____

Washing machine

[] 1 Has
[] 4 Does not have

Hot water heater

[] 2 Has
[] 3 Does not have

Code ____

Television

[] 1 Has
[] 4 Does not have

Refrigerator

[] 2 Has
[] 3 Does not have

Code ____

13. Tenure (occupied by:)

(mark only one box)

[] 1 Renter
[] 2 Owner
[] 9 Other

14. Monthly rent

(write on one line only)

____ colones (exact) - renter -
____ colones (estimated) - owner -
____ colones (estimated) - other-

15. Rooms and bedrooms

(write in both spaces)

____ Number of rooms
____ Of these, how many are used as bedrooms?

16. Residents in this dwelling

____ Males
____ Females
____ Total

17. Domestic industry

[] Has
[] Does not have

If any, indicate:

a) products made for sale:
____
b) non-family personnel employed (number)
____

Comments: [10 blank lines]

Enumerator

____ Name
____ Signature
____ Date of enumeration

Reviewer

____ Name
____ Signature
____ Date of review

The information solicited is obligatory and confidential under Law 565 of May 20th 1953.
Printed in Estadística y Censos Form 396-350000

Population Census

General Characteristics
For all individuals

1. Name and surnames of the people who live in the dwelling. Do not forget to include newborns as of March 31st 1963.

____
____
____

2. Relationship to head. Mark the appropriate box according to the relationship the person has to the Head of the "Census Family" or with the head of the "Non-family Group." Remember to specify the relationship when using the blank in "other."

[] 1 Head
[] 2 Wife
[] 3 Companion
[] 4 Son or daughter
[] 9 Other (specify) ____

3. Sex
Mark the appropriate box

[] 1 Male
[] 2 Female

4. Age

Write on one line only.

For those one year of age and older:

____ Number of years 1

For children between one and eleven months of age:

____ Number of months 2

For those under one month:

____ Number of days 3

5. Marital Status

Mark only one box

Single: one who has never contracted matrimony and does not live in a consensual union

Married: one who has contracted matrimony and lives in that estate

Widowed: one who has not contracted matrimony since the death of a spouse and who does not live in a consensual union

Divorced: one who definitively undid a marital bond through legal means

Consensual union: one who lives in a marital union without having contracted matrimony

Married Separated: one who contracted matrimony and lives apart from the spouse

[] 1 Single
[] 2 Married
[] 3 Widowed
[] 4 Divorced
[] 5 Consensual union
[] 6 Married separated

Migration:

6. How long have you lived in this canton?

Mark the box "always" if the person has only lived in this canton. Otherwise write the number of years.

[] Always
____ Number of years

7. In which canton did you live previously?

Mark an "X" if the person has only lived in this canton. Otherwise write the canton or the country of previous residence.

____

8. Place of birth.

Mark an "X" if the person's mother lived in this place at the time of the person's birth. If the mother lived in another canton write the canton. If the mother lived abroad write the country.

____

9. Nationality

Mark and "X" if Costa Rican by birth and "NX" if Costa Rican by naturalization. If foreign, write the appropriate nationality.

____

10. Social security

Mark the appropriate box according to whether the person is protected or not, directly or indirectly, by the social security.

[] 1 Yes
[] 2 No

Educational Characteristics

Only for those 7 years of age and older [applies to questions 11 to 13]

11. Currently attending

Ask both questions.

Are you currently attending school, high school or university?

[] 1 Yes
[] 2 No

Are you currently attending other educational institutions (specify: vocational school, business school, etc.)

____ [] 1

12. Last grade or year completed:

Write the number of the grade or year on the appropriate line. Mark the box "04" if the person has not completed any grade.

____ 1 Primary
____ 2 Secondary
____ 3 University
[] 04 No grade

13. Able to read and write?

Mark the appropriate box

[] 1 Yes
[] 2 No

Occupational Characteristics

Only for those 12 years of age and older [applies to questions 14 to 19]

14. General classification - Mark the appropriate box

Employed: one who worked 6 days or more during the month of March 1963
Student: one who only studied during March 1963
Unemployed: one who did not work or worked fewer than 6 days in March 1963
Household duties: one who only did household work
Other: pensioner, retiree, rentier, beggar, insane, institutionalized, etc.

[] 1 Employed
[] 2 Student
[] 3 Unemployed
[] 4 Household duties
9 Other (specify) ____

Items 15 - 18 are only for "employed" and "unemployed"

15. Occupation

Write the principal occupation during the month of March, 1963. If "unemployed" ask and write the last occupation. Examples: musician, doctor, teacher, agricultural laborer, lawyer, bricklayer, etc.

____

16. Industry

Write the type of company or activity in which the person works. Examples: Orchestra, doctor's office, government ministry, plantation, law office, construction, etc.

____

17. Occupational category (employment status). Mark the appropriate box

Owner: one who operates his own company and has paid workers
Family worker: one who works in the company of a relative without receiving payment
Paid worker: one who receives payment, in money or in kind, for working
Own-account worker: one who operates his own company and does not have paid workers

[] 1 Owner
[] 2 Family worker
[] 3 Paid worker
[] 4 Own-account worker

18. Wage or salary: only for "paid workers."

Write the amount of income from pay obtained during the month of March 1963. Write the daily or monthly wage and always indicate the number of days to which that payment applies.

____ colones per day
____ colones per month

____ Number of days

19. Length of employment

Write the number of months worked during the last year (from April 1st 1962 to March 31st 1963)

____ Number of months

Comments: [2 blank lines]

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