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II National Census of Population
and
I of Housing

November 25th, 1962

A. Identification

(1) ____ Name of populated area
(2) ____ Enumeration area number
(3) ____ Street or route (residential address) ____ Number
(4) ____ Name of owner of building
(5) ____ Dwelling order number within the building

B. Geographic Location

(1) ____ Province
(2) ____ Canton
(3) ____ Parish

(4)
[] Urban
[] Rural

(5) ____ Category
(6) ____ Zone
(7) ____ Sector
(8) ____ Block or population center
(9) ____ Form number

C. Population

Questions 1-18 were asked to each person in the dwelling.

I. (1) Names and surnames

Write the names and paternal and maternal surnames of each of the people who spent the night of November 24th in this dwelling.

Begin with the head of the census household, and include minors and newborns, domestic servants, etc.
____

II. (2) Relationship to the head of the household

Head
Wife or female companion
Son
Mother
Uncle
Guest
Servant
Etc.
____

III. (3) Sex

H = Male
M = Female
____

IV. Place of birth

If born in the country, write the name of the province. If born abroad, write the name of the country.
(4) ____ Province or country

Write the name of the city or the rural parish of birth.
(5) ____ City or rural parish

V. Place of prior residence

Write the name of the province or of the country of prior residence
(6) ____ Province or country

Write the name of the city or the rural parish of prior residence
(7) ____ City or rural parish

(8) ____ Resident (R) or Transient (T)
VI. (9) ____How many years residing in this place?

VII. (10) ____Age (in years completed)

VIII. Educational

For those 6 years of age and older:
[Applies to questions 11 through 13]

(11) Currently attending any educational institution?
Yes or No
____

(12) Able to read and write?
Yes or No
____

(13) Highest grade completed
____
Only for those 12 years of age and older
[Applies to items 14 through 18]

IX. (14) Marital Status

1 Single
2 Married
3 Consensual Union
4 Widowed
5 Divorced
____

X. Economic Characteristics

(15) Class
1 Employed
2 Unemployed
3 Looking for work for the first time
4 Household duties
5 Student
6 Rentier
7 Institutionalized
8 Other (specify)
____

(16) Occupation
Farmer
Shoemaker
Clerk/scribe
Bricklayer
Mechanic's apprentice
Etc.
____

(17) Industry or branch of economic activity
Plantation agriculture
Shoemaker's workshop
Municipality
Construction of houses
Mechanic's workshop
Etc.
____

(18) Occupational category or employment status
Owner/boss
Own-account worker
Employee
Salaried worker
Unpaid worker
Other
____

D. Dwelling

Building type
[Refers to items I and II.]

I. Private (Family)

[] 01 House
[] 02 Villa
[] 03 Mediagua (small unit with sloped roof)
[] 04 Shack (covacha)
[] 05 Rustic cabin (choza)
[] 06 Rancho (poor construction possibly with cane or straw roof)
[] 07 Other ____ (specify)

II. Non-family

[] 11 Hotel, boarding house, inn, etc.
[] 12 Hospitals, asylums, etc.
[] 13 Convents, dormitories, etc.
[] 14 Prisons, reformatories
[] 15 Barracks
[] 16 Worker's camps
[] 17 Other ____ (specify)

Only for private, occupied dwellings
[Refers to items III through X]

III. Predominant building materials

In the walls:

[] 1 Cement, stone or brick
[] 2 Adobe or mud wall (tapia)
[] 3 Covered cane
[] 4 Wood
[] 5 Cane
[] 6 Other ____ (specify)

In the floors:

[] 1 Wood
[] 2 Tile or cement
[] 3 Brick
[] 4 Cane
[] 5 Earth
[] 6 Other ____ (specify)

IV. Water supply

[] 1 Running piped water. Exclusive use by the dwelling.
[] 2 Running piped water. Common use within the building.
[] 3 Running piped water. Outside the building.
[] 4 Spring
[] 5 Well
[] 6 River or stream
[] 7 Cistern

V. Toilet facilities

[] 1 Toilet for exclusive use of the dwelling
[] 2 Toilet for shared used in the building
[] 3 Latrine or pit toilet
[] 4 None of the above facilities

VI. Electric lighting

[] 1 Yes
[] 2 No

VII. Tenure

[] 1 Owned
[] 2 Rented
Other ____ (specify)

VIII. Monthly rent (For rented dwellings)

____ S./

IX. Number of rooms

____ (Exclude the kitchen, hallways and bathroom)

X. Separate room for kitchen

[] 1 Yes
[] 2 No

Office [for administrative use only]

____

Number of occupants in the household

____ Males
____ Females
____ Total