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Council of Ministers of the German Democratic Republic
Central Office for Statistics
Population, occupational, housing, and building census on December 31, 1981

Residence ZB _ _ _

Household/person number _ _ _

Person list

1. Last name, first name ____

2. Gender

[] 1 Male
[] 2 Female

3. Date of birth

Day _ _
Month _ _
Year _ _ _ _

4. Address of the main residence (according to the identity card)

____ City
____ Street, number
____ District

Address of the secondary residence (according to the identity card)

____ City
____ Street, number
____ District

5. Marital status

[] 1 Married
Year of marriage: _ _ _ _
[] 2 Single
[] 3 Widowed
[] 4 Divorced

6. Number of children born (only to be filled out for women): _ _

7. What type of income do you draw? (Please mark all applicable types)

[] 1 Income from employment
[] 2 Apprentice's wages/scholarship
[] 3 Pension/retirement
[] 4 Disability pension/social benefit
[] 5 Other types of social benefit
[] 6 No individual income
Which other types? ____

8. Are you currently:

[] 1 Pupil
[] 2 Apprentice
[] 3 Full-time university student

9. Education completed

[] 1 Eighth grade
[] 2 Tenth grade
[] 3 Abitur [qualification for university entrance]

10. Vocational education completed (please mark all applicable circles)

[] 1 Semi-skilled worker; occupation ____
[] 2 Skilled worker; occupation ____
[] 3 Master; occupation ____
[] 4 Vocational college degree; field ____
[] 5 University degree, field ____
What other education? ____

Fill out questions 11-13 for employed persons only (not apprentices).

11. Are you employed as:

[] 1 Worker/employee
[] 2 Agricultural production cooperative member
[] 3 Other cooperative member
[] 4 Person of liberal professions
[] 5 Self-employed
[] 6 Family worker

12. Job held at the place of work: ____

13. Name and address of the place of work

____ Name
____ City, street, number
____ District

Location of work (in case this does not coincide with the address of the place of work)

____ Work city, street
____ District

Fill out question 14 for persons that are no longer in the labor market.

14. Were you last:

[] 1 Worker/employee
[] 2 Agricultural production cooperative member
[] 3 Other cooperative member
[] 4 Person of liberal professions
[] 5 Self-employed
[] 6 Family worker