Republic of Costa Rica
General Directorate Of Statistics and Censuses

National Censuses - May 1973
III of Housing
VII of Population

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

[] Urban
[] Rural

_ _ Office use
_ _ _ _ Dwelling number (visit order)
____ Neighborhood or hamlet
____ Highway, route, etc.
____ Avenues (numbers)
____ Streets (names)
____ Institution (name)

Dwelling

1. Type

Private dwelling:

[] 1 Ordinary
[] 2 Shack (rancho)
[] 3 Marginal
[] 4 Mobile

[] 5 Collective dwelling

2. Occupancy - tenure - rental

Occupied:

[] 0 Rented

____ colones monthly rent

[] 1 X owned
[] 2 X other (specify)

Unoccupied:

[] 3 For rent
[] 4 For sale
[] 5 Summer home
[] 6 Under repair
[] 7 Under construction
[] 8 Other (specify) ____

[] 9 Unknown

Predominant materials

3. In the exterior walls

[] 1 Wood
[] 2 Cemented material (brick, cement block, metal sheet, etc.)
[] 3 Adobe or cane with earth covering (bahareque) (not cemented)
[] 4 Other (specify) ____

4. In the floor

[] 1 Wood
[] 2 Tile
[] 3 Earth
[] 4 Other (specify) ____

5. In the roof

[] 1 Clay tiles
[] 2 Metal sheet (zinc, etc.)
[] 3 Asbestos cement
[] 4 Other (specify) ____

6. Condition

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

7. Rooms and bedrooms

Total number of rooms ____
Of these, how many are bedrooms? ____

8. Water supply

By pipe:

Public system

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

Private system

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

By other means:

[] 5 Well
[] 6 Public source
[] 7 Other (specify) ____

9. Bathroom facilities

By pipe:

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

[] 3 By other means (specify) ____
[] 4 None

10. Type and use of toilet facilities

Sewer

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

Septic tank

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

Concrete pit toilet

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

Wooden pit toilet

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

Other type

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

None

[] Y

11. Lighting type

Electric

[] 1 From public utility
[] 2 From private generator
[] 3 From another source

Other types

[] 4 Kerosene (canfín)
[] 5 Other (specify) ____

[] 6 None

12. Cooking fuel

[] 1 Electricity
[] 2 Propane gas
[] 3 Kerosene (canfín)
[] 4 Charcoal
[] 5 Wood
[] 6 Other (specify) ____
[] 7 No cooking

13. Appliances in the dwelling

Radio - television

[] 1
[] 2
[] 3
[] 4

Stove - refrigerator

[] 1
[] 2
[] 3
[] 4

Washing machine - hot water heater for bath

[] 1
[] 2
[] 3
[] 4

Electric iron - vacuum cleaner

[] 1
[] 2
[] 3
[] 4

Telephone

[] 1
[] 2

Residents in this dwelling
(Summary by the enumerator)

____ Males
____ Females
____ Total

Enumerator

____ Name
____ Signature
____ Date of enumeration

Reviewer

____ Name
____ Signature
____ Date of review

Comments: [5 blank lines]

[Table headings:]

Number
Questions
First Person
Second Person

[End of table headings]

PERSONS

1. Name and surnames:

Write the name and surnames of the people who habitually live in this dwelling. Do not forget to list babies born as of May 13th 1973.

____
____

2. Relationship to the head:

Mark the appropriate circle according to the relationship of the person to the "Head of the Census Family" or to the "Head of the Non-Family Group."
When using the "other relatives" space, specify the relationship- circle 3
When using the "other non-relatives" space, specify the relationship- circle 5

First Person

X Head

In this column, put only information pertaining to the "Head of the Census Family" or "Head of the Non-Family Group."

Second Person

[] 1 Wife or companion
[] 2 Son (Daughter)
[] 3 Other relatives (specify) ____
[] 4 Servants and their relatives
[] Other non-relatives (specify) ____

3. Sex

Mark the appropriate circle

[] 1 Male
[] 2 Female

4. Age

Write in one space only.

For those one year of age and older, write the number of years.

Number of years ____

For those under one year, mark the circle

[] YY Less than 1 year

Only for women 15 years of age and older:
[Applies to questions 5 - 6]

5. How many living children have you had?

[] 00 None
____ Children
[] YY Unknown

6. How many children currently alive do you have?

[] 00 None
____ Children
[] YY Unknown

7. Current marital status: Mark only one circle.

Single: a person of any age who has never contracted matrimony and does not live in a consensual union.
Married: one who contracted matrimony and lives in that state.
Widowed: one who has not contracted matrimony since the death of a spouse, nor lives in a consensual union.
Divorced: one who is legally separated and has neither remarried nor lives in a consensual union.
Consensual union: one who lives in a marital union.
Married separated: one who contracted matrimony and lives separately from the spouse, and does not live in a consensual union.

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

8. Habitual place of residence 5 years ago.

This question refers only to people 5 years of age and older.
Mark the circle "Here" if the person has lived in this canton for five or more years.
If the person lived in another canton or country in Mary 1968, write the name of the canton or country.

[] X Here _ _ _
____

9. Place of birth

Mark the circle "Here" if the mother lived in this canton at the time of the person's birth.
If the mother lived in another canton write that canton. If the mother lived abroad write the country.

[] X Here _ _ _
____

10. Nationality

Mark the "X" circle if Costa Rican by birth.
Mark the "YX" circle if Costa Rican by naturalization. If a foreigner, write the appropriate nationality.

[] X
[] YX _ _
____

11. Social security

Mark only the appropriate circle according to the coverage status of the enumerated person.

[] 1 Directly covered
[] 2 Covered by family member
[] X Not covered

12. Mark only the appropriate circle according to the type of coverage of the enumerated person.

[] 3 Illness and maternity
[] 4 Disability, old age and death
[] 5 Both coverages

Only for people 6 years of age or older
[Applies to questions 13 - 16]

13. Attending school, high school or university?

[] 1 Yes
[] 2 No

14. Attending another non regular education center? Specify: commercial, I.N.A., sewing, etc., or if not attending mark a "Y" in the "No" box.

____
[] No

15. Level of instruction

What is the last grade or year of regular schooling completed, whether primary, secondary or university? Write the number corresponding to the last grade or year of regular schooling completed, after the respective level.
If the person has not completed any grade, mark the circle 40.

1 Primary ____
2 Middle (secondary) ____
3 University ____
[] 40 No grade

16. Literacy. For individuals 10 years of age and older: Are you able to read and write?

[] 1 Yes
[] 2 No

Only for individuals 12 years of age and older
[Applies to questions 17 - 22]

17. Activity status.

Mark only one circle according to the instruction on page 47 of the Enumerator's Manual.

[] 1 Worked
[] 2 Did not work
[] 3X Looked for work for the first time
[] 4X Student
[] 5X Household duties
[] 6X Pensioner or rentier
[] 9X Others (specify) ____

Only for those who "worked" or "did not work"
[Applies to questions 18-20]

18. Principal occupation

Specify the principal occupation held during the week of May 7th - 12th.
If the status was "did not work," write the last occupation held.
Do not forget to write the answer according to the instructions on page 47 of the Enumerator's Manual.

____ _ _ _

19. Industry

Write the type of activity or establishment in which the occupation noted in the previous question is pursued.
If the status was "did not work," write the type of establishment in which the most recent occupation was pursued. Do not forget to write the answer according to the instructions on page 47 of the Enumerator's Manual.

____ _ _ _ _

20. Occupational category (employment status)

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

21. Hours worked

Answer only for those people whose status was "worked" and who are "paid workers," following the instructions on page 50 of the Enumerator's Manual.

____ Hours

22. Wage or salary

Answer only for those people whose status was "worked" and who are "paid workers," following the instructions on page 50 of the Enumerator's Manual.

Wage per ____
____ colones

Comments: [2 blank lines]

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