Fourth Census of Canada, 1901
____ Province
____ District
____ S. District number
____ Polling sub-division
____ City, town, village, township or parish
____ Page
Nominal return of living persons by enumerator
Numbered in the order of visitation
____ Dwelling house number
____ Family or household number
____ Name of each person in family or household on March 31, 1901
____ Sex
____ Colour
____ Relationship to head of family or household
____ Single, married, widowed or divorced
____ Month and date of birth
____ Year of birth
____ Age of last birthday
2. Citizenship, nationality and religion
____ Country of place of birth (If in Canada, specify Province or Territory)
____ Year of immigration to Canada
____ Year of naturalization
____ Racial or tribal origin
____ Nationality
____ Religion
3. Principal profession or trade
____ Living on own means
____ Employer
____ Employee
____ Working on own
4. Wage earner
____ Mostly employed at trade in factory
____ Mostly employed at trade in home
____ Mostly employed in other occupation than trade in factory or home
____ Earnings from occupation or trade
____ Extra earning (from other than chief occupation or trade)
5. Education and language of each person five years of age and over
____ Can read
____ Can write
____ Can speak English
____ Can speak French
____ Mother tongue (if spoken)
6. Infirmities (If the infirmity dated from childhood add "from childhood")
____ Blind
____ Unsound mind