To be filled out by the census agent

Section to be filled out by the census agent
_ _ Neighborhood number
_ _ _ District number of the census (or the block)
_ _ _ Building number
(in order to attribute an order number, see page 3 of form number 6)

Mayor's seal
_ _ _ Do not write anything in this grid
Establish a housing form
1. For every construction resided in, whatever its nature, whatever materials are used, including dilapidated buildings, make-shift homes; including as well the buildings still being constructed which are partially inhabited.
2. For all constructions used for housing, even without occupants at the time of the census (vacant dwellings and secondary dwellings), with the exception of destroyed buildings or which have become uninhabitable or which have become uninhabitable due to it being run-down.
3. For all kinds of administrative, industrial or commercial buildings, even uninhabited. For special cases, refer to the Census Agent Manual.

___ Specific Address (or place name)
___ City
___ County
___ Give all other indications pertinent to locating the building.

List of dwelling accommodations
Use one line for each accommodation dwelling of categories 1 to 7 outlined on the first page of the dwelling form (file the dwelling forms of the building inside the form in the order of the list below). If there is no dwelling accommodation in the building, write "none" on the first line.
Do not record the sites occupied by the part of the population counted separately or by public housing (the corresponding forms number 3 and number 1bis will not be filed in the house forms).
(According to column 4 below) Number of
___ Main residences (categories 1 to 5)
___ Vacant dwellings (category 6)
___ Secondary residences (category 7)
___ Total number of dwelling accommodations

To be filled out by the census agent
___1 Dwelling number*
___2 Location in the building** (stairs, floor, situation on the stairway platform, apartment or bedroom number, etc.)
___3 Name of the occupant
___4 Dwelling category (1 to 7) see FL
___5 Number of number 2 forms (list A only) ****

To be filled out by the mayor
Number 2 forms
___ 6 deleted (used twice with forms 2 bis B)
___ 7 added (forms received for people moving and not used twice)
___ 8 Number of forms 2 bis B reintegrated
Following the list on page 4
Total
___ Partial (refer to page 4)
___ General
*To fill out according to the dwelling forms gathered.
** To fill out when turning in dwelling forms.
*** Count only forms 2 which you have gathered for people recorded in lists A. The number of forms possibly established for people passing through (section C) will be indicated all together on the district form.
(L) 7 671208 0
Visa du C.O.C.O.E.S. 68/008

[p.2]
1. Building type

[] 1 Farm, agricultural buildings
[] 2 Make-shift housing (such as a train car, shantytown shack, building inhabited although in ruins, etc.)
___ Specify
[] 3 Temporary construction used as a residence.
[] 4 Hotel, boarding house, furnished apartment (occupying all or most of the building).
[] 5 Individual house or public building entirely or mostly used as a residence.
[] 6 Building mostly for industrial, commercial, administrative or public use; such a building can consist of one or several dwelling accommodations for housed personnel (this is often the case for a director or concierge, etc.)
___Specify the exact nature of the building.
Examples: factory, workshop, store, warehouse, mall, shop, movie theater, bank, building made up of office suites.
Hospital, clinic, rest house, sanatorium, dispensary, asylum.
School, boarding school, middle school.
Administrative building, city hall, military barracks, train station, post office, museum, church, stadium, etc.
___ If you are hesitant about a particular case, describe it.

Characteristics of the building

2. Main materials

Walls
[] 1 Stone, dressed stone, millstone, building stone, brick, hollow brick, cement, chip wood, cinder block
[] 2 Other materials such as: wood, wood beams and cob, clay masonry, etc.
____ Specify
Roof
[] 1 Tile, slate, asbestos or similar material; aluminum, steel, copper, zinc, terrace.
[] 2 Other materials such as: straw, sheet metal, flat stone, bitumen, etc.

3a. ___ Number of floors above the ground floor:
Including the attic garrets. Do not count cellars or basements. The heightened basement is considered an ordinary basement, but the mezzanine counts as a floor.
If there are several groups of buildings, indicate the number of floors of the highest buildings.

3b. ___ Number of levels above ground floor

4. Elevator

Is there an elevator in the building?
[] 1 Yes
[] 2 No

5. Year the construction was completed

If various parts are not from the same time period, indicate the year of completion of the most important inhabited section. In the case of renovation or raising the height, indicate the year of the reconstruction or heightening.
[] 1 Before 1871.
[] 2 From 1871 to 1914.
[] 3 From 1915 to 1939.
[] 4 From 1940 to 1948.
[] 5 From 1949 to 1953.
In the following cases, specify the year of completion: 19 _ _
[] 6 From 1954 to 1961
[] 7 1962 or after.
[] 8 Building being constructed and partially inhabited.

6. Water source for domestic use.

Public supply
[] 1 Building connected to a collective network of distribution (city; village; service of waters; plant, etc)
[] 2 Fire hydrant, fountain, source or public wells
Well, tank, fountain, or private source
[] 3 With pipe connection in the building
[] 4 Without a pipe connection in the building

[p.3]
Do not write in the grids below
Characteristics of the Building (continued)

7. Gas
8. Electricity

Is the building connected to an electricity distribution network?
[] 1 Yes
[] 2 No

9. Drainage from bathrooms and household water

9a. Toilets
[] 1 Direct connection to the sewer (without passing through a septic tank)
[] 2 Septic tank.
[] 3 Cesspit (with or without period draining).
9b. Household water (sink, laundry, hygiene, etc.).
[] 1 Direct connection to sewer
[] 2 Other cases (gutter, ditch, sump, etc.)

10. Central heating

[] 1 Urban heating
[] 2 Public heating for a group of buildings.
Building with three or more dwellings
[] 3 With public heating for the building itself (serving the whole building or only the shared spaces, or several dwellings).
[] 4 Without public heating installation (some dwellings able to possess individual installations)
Building with 1 or 2 dwellings
[] 5 With installation of central heating.
[] 6 Without installation of central heating.
If you have checked one of the boxes numbered 2, 3 or 5, indicate the fuel used:
[] 1 Coal.
[] 2 Oil.
[] 3 Gas.
[] 4 Wood
[] 5 Others. Specify: ___

11. Farms

Is this building the center of one (or more) farm(s)?
[] Yes
[] No
If yes:
First farm
a. ____ First and last name of the farmer:
b. Acreage (Do not count woods, meadows, undergrowth ,quarries, pools, building sites, parks and flower gardens)
[] 1 less than one hectare
[] 2 1 to less than 5 hectares
[] 3 5 to less than 10 hectares
[] 4 10 to less than 15 hectares
[] 5 15 to less than 20 hectares
[] 6 20 to less than 50 hectares
[] 7 50 hectares or more
c. Specialization:
If the farm has a surface area of less than 5 hectares, indicate its specialization:
[] 1 Viticulture
[] 2 Arboriculture
[] 3 Market gardening
[] 4 Pig farming or aviculture
[] 5 Other specializations:
___ Specify
[] 6 Farm not specialized
Second Farm
a. First and last name of the farmer:
b. Acreage ( do not count woods, meadows, undergrowth, quarries, ponds, building sites, parks and flower gardens)
[] 1 less than one hectare
[] 2 1 to less than 5 hectares
[] 3 5 to less than 10 hectares
[] 4 10 to less than 15 hectares
[] 5 15 to less than 20 hectares
[] 6 20 to less than 50 hectares
[] 7 50 hectares or more.
c. Specialization
If the farm has a surface area of less than 5 hectares, indicate its specialization
[] 1 Viticulture
[] 2 Arboriculture
[] 3 Market gardening
[] 4 Pig farming or aviculture
[] 5 Other specializations:
___ Specify
[] 6 Farm not specialized

[p.4]
List of Dwelling Accommodations (continued from page 1)

To be filled out by the census agent
___1 Dwelling number*
___2 Location in the building (stairs, floor, location on the stairway landing, apartment or bedroom number, etc.)**
___3 Name of the occupant**
___4 Dwelling category (1 to 7) see FL**
___5 Number of number 2 forms established (list A only)
To be filled out by city hall
Number of number 2 forms
___6 Deleted (used twice with number 2 bis forms)
___7 Added (forms received for people moving and not being used twice)
___8 Number of number 2 bis forms reintegrated
If there are more than 25 dwellings, use one or more additional forms as dividers while giving them the same building number as the first form.
Total
___ Sub-total (refer to page 1 of the following divider, on the first line of the list)
___ General (to fill out on the last building form. Refer to page one of the first form)
*To fill out after gathering the dwelling forms.
** To fill out when turning in dwelling forms.
*** Count only forms 2 which you have gathered for people recorded in lists A. The number of forms potentially established for people passing through (section C) will be indicated all together on the district form.



Section to be filled out by the census agent
_ _ Neighborhood number
_ _ District census number (or block)
_ _ _ Building number
_ _ Dwelling number (or mobile home)

Mayor's stamp
How to fill out the forms
You will first fill out the present form by beginning with pages 2 and 3 (list of the people living in the dwelling), then continue on page 4 (composition and make-up of the dwelling). Then, for each of the people recorded on list A of page 2, you will fill out an individual form (form number 2).
Before answering a question, carefully read the corresponding explanations; for some questions, small boxes have been provided for your answer. So clearly put an X in the one which corresponds to your situation. For example, a man will answer question 2 of the individual form: [X]1 Male
If a question does not apply to you, draw a line through the place provided for the answer.
As a general rule, do not leave the smallest question without a response.
Write last names in capital letters.
By observing these recommendations and following the instructions which will be provided to you by the census agent, you will facilitate the work of the National Institute of Statistics and Economic Studies (I.N.S.E.E.), who thanks you.

Why the Census?
The general census of the population is an procedure in which the whole country regularly participates. Its purpose is to determine the number of inhabitants in each city, to know the demographics of the population according to age, profesion, kind of activity, analysis of migrations, the composition and set-up of buildings and dwellings, etc. This information is essential to the study of all demographic, economic, and social problems at the national or regional level.
Required by the mandate of May 16th, 1967 (Official Journal of May 18th, 1967), the general census of 1968, the 29th since 1801, is necessary for all people residing in France.
The law of privacy in the collection of statistics (June 7th, 1951) guarantees that the individual information appearing on the questionnaires of the census will only be used for the establishment of anonymous statistical charts. They will not be used for fiscal ends or for any sort of administrative control.

Section to be filled out by the census agent
Dwelling occupied by Mr./Mrs./Ms. ___
Number of number 2 forms established (list A only) (Box to fill out after verification of collected forms)
Very specific address
___ Street (or place name)
___ City (For Paris, Lyon, Marseille, add the neighborhood district)
___ County
___ Specify the location of the dwelling in the building (stairs, floor, position on the stairway landing, apartment or bedroom number, etc.)

Dwelling Category
Main residence

___ If you find yourself in a different situation which you hesitate to classify in the list above, describe it.
In the case of public housing, establish a public housing form (form number 1bis).

[p.2]
List of people living in the dwelling
Each person normally living in the dwelling, even if he/she is absent at the time of the census, must be recorded in either list A or B below. Do not forget young children.
Note: If you have a secondary residence (for example, a country house or vacation home), you should not fill out lists A and B below except for your main residence. Your individual forms should be filled out a single time, in the city of your main residence.

List A
Record below the people living in the dwelling, including people traveling on business or for pleasure, sick people spending time in the hospital or in a clinic, fishermen still at sea, personnel navigating planes or ships.
Do not include people listed in the heading of list B on the opposite side of this page.
If you are housing servants, apprentices or employees in your service, record them here below (list A).
If you have boarders (or daycare children) who are living at your home, record them below (list A).
If you are subletting (or if you are leasing) part of your dwelling, record below your subletters (or the people you are hosting). Always, if these subletters (or hosted people) live in totally independent rooms, meaning that they have access to the outside either directly or through a liaison of the shared parts of the building (stairs, entryway, etc.). For example, a maid's room entirely separate from the dwelling. You should consider that these independent rooms form a distinct dwelling for which a new dwelling form must be established. In this case, do not record the subletters in the list below, and do not count the rooms which they occupy in the composition of the dwelling (page 4).

Fill out an individual form number 2 for each person on list A
___ 1 Last name (for a woman, add the maiden name)
___ 2 First name
___ 3 Relationship to the head of household (indicate for example: Head of household, spouse, son, mother, daughter-in-law, nephew, etc. Or even: friend, boarder, subletter, maid, housed employee, etc.)

If there are more than 15 people to record, use an additional dwelling form.

List B
Record below the people who make up your household and who are currently found in one of the following situations:
Sick in a sanatorium [sanatorium, préventorium, aérium];
Drafted service;
Career military serving outside of France;
Children placed in a boarding school. Students housed somewhere else during the school year (except for kids and student placed in an establishment outside of France) who should be recorded in list A);
Children in daycare somewhere else;
Children placed as servants, employees or apprentices and living in the homes of their employers (or in the workplace):
Elderly people and disabled placed in a hospice, a retirement home, an asylum or a psychiatric hospital.
Other people absent for a long duration (more than 6 months).
Do not fill out an individual form for the people from list B (their forms will be established in the place where they are currently traveling).
___ 1 Last name and first name
___ 2 Relationship to the head of household
___ 3 Date and place of birth
___ Born on
In:
___ City
___ County
___4 Name and Address of the Establishment (or the dwelling) where the person concerned currently stays
C. Situation of people passing through who are at your home at the time of the census but having their usual residence somewhere else (Parents, friends, travelers, etc.)
1. Do not record these people in lists A and B above in any case
2. Do not fill out individual forms for them.
Always if they are absent from their usual residence during the entire duration of the census operations (March 1st through 23rd, 1968) and if there is no one at that residence to answer in their place:
a. Establish their individual form (without recording them in lists A and B) while mentioning their usual address in the section reserved for this purpose at the bottom right of the form;
b. Turn in these forms separately to the census agent. They will be sent to the mayor of their usual residence.
D. If you have any hesitations about the situation of a person, (ask yourself if it is necessary to record him/her in list A or in list B), please indicate what this person is:
___ Last name
___ First name
___ Born on
In
___ City
___ County
___ Indicate in which situation the person currently is in.

[p.4]
Composition and set-up of the dwelling

1. Do you have a kitchen?

[] Yes
What is the surface area?
[] 1 less than 7 squared meters
[] 2 from 7 to 12 squared meters
[] 3 more than 12 squared meters
[] No
However, do you have an installation in your dwelling for preparing food?
[] 5 Yes
[] 6 No
Do not answer "yes" except if this installation consists of a sink allowing water to drain

2. ___ Indicate, if there is space, the number of dwelling rooms having an exclusively professional use
(for example: businessman's office, medical or law office, tailor's apartment workshop, etc.)

3. Number of dwelling accommodation: not including the kitchen or rooms exclusively for professional use
Count as dwelling places rooms such as the bedroom, dining room, salon, common room, studio, living room, etc. whatever their surface area, as well the maid's room and attic garrets.
Do not count as dwelling places rooms such as entranceways, hall, bathroom, closet, alcove, W.C., laundry, office, etc.
Special case of independent rooms (for example: maid's room separated from the main dwelling)
Count these rooms amongst your dwelling places if you use them yourself (either for housing a member of your household: child, servant, etc.; or as a storage room, etc.)
Do not count them if they are rented, sublet, or leased to other people. In this last case, they constitute, in the meaning of the census, a distinct dwelling and their occupants will fill out a new dwelling form.

4. Are you

[] 1 owner of the house or the building where your dwelling is found? including various forms of access to your property (including sale or rent)
[] 2 owner of your dwelling in a condominium?
[] 3 housed by your employer (for free or for a fee) for the duration of your work function or work contract?
[] 4 housed for free, for example by parents? (including the case of people occupying a dwelling that they have sold for life annuity).
[] 5 renter or subletter of an empty rented space?
[] 6 renter or subletter of a furnished rented space, a hotel room, or furnished apartment?
___ If you are in a case not provided above, describe it:

5. Water source

Water running in the dwelling
[] 1 Cold water only
[] 2 One or more hot water valves. (individual hot water or shared heater)
[] 3 No running water in the dwelling but water point inside the house (or the same floor or another floor)
[] 4 Water valve outside the house (faucet or pump in the yard, a well, fire hydrant, etc.

6. Gas Boxes 1 and 2 can, depending on the situation, are both to be marked

[] 1 Dwelling connected to a public distribution network (city gas, Lacq gas, etc.)
[] 2 Use of bottled gas (butane, propane, etc.).
[] 3 Neither connected to a public network nor bottled gas

7. Sanitary installations: Do you have a bathtub or a shower installed with running water and drain?

[] 1 Yes
[] 2 No

8. Toilets (W.C.)

Located inside the dwelling
[] 1 with flush
[] 2 without flush
Located outside of the dwelling but reserved only for its occupants
[] 3 with flush
[] 4 without flush

9. Central heating
10. Telephone

Is it installed in the dwelling?
[] 1 Yes
[] 2 No

11. Does one of the inhabitants of the dwelling (mentioned in list A) use a personal vehicle?

[] 1Yes
[] 0 No

To be filled out after the housing form



Form number 2
This form will be filled out for every person recorded in list A of the housing form including young children.
When small boxes are provided for your response, put a cross in the one which corresponds to your situation.

Box to be filled out by the census agent:
Neighborhood quarter _ _
Census district (or block) number _ _ _ _
Building number _ _ _ _
Dwelling number (or mobile home or shared household number) _ _

1. First and last names

Write your last name in capital letters. Women will include their maiden name (example: Maurin, born Allard, Marie, Lucie).

2. Sex

3. Marital status
Put a cross in the only box which corresponds to your current situation. Thus, a widower (or a divorced man) who is remarried will mark the second box.

[] 1 Single
[] 2 Married
[] 3 Widow(er)
[] 4 Divorced

4. Date and place of birth

Born on (day, month, year) ____
in city (for Paris, Lyon, Marseille, include the city neighborhood ____
Department (or country for territories overseas and for foreigners) ____
If you were born in a overseas territory or abroad, specify the year of your arrival in France. ____

5. Nationality

[] French by birth (including by reintegration)
[] French by naturalization, marriage, declaration or option
Indicate your previous nationality ____
[] Foreigner
Indicate your nationality ____

6. Address

Street (or place name) ____
Number ____

7. Where were you living on January 1st, 1962? (for all people born before January 1st, 1962).

City (for Paris, Lyon, Marseille, include the city neighborhood) ____
Department (or country, for overseas territories and abroad) ____

If, on January 1st, 1962, you were living in the same address as now, indicate, "same address".
If you were in the military at that time or a boarding student or undergoing treatment in a care facility, indicate the address of your personal residence at that date and not that of the establishment (barrack, boarding school, sanatorium, etc.).
If, on January 1st, 1962, you were living in an overseas territory or abroad, when did you come (or return) to live in Metropolitan France?

Month ____
Year ____
196 _

Education and professional formation (for all persons born before January 1st, 1962)
[Applies to questions 8 - 11]

8. Are you currently a student?

[] Yes (Answer question 9)
[] No (Answer questions 10 and 11)

Do not answer "yes" unless you are taking classes (including professional or technical classes) or at the university for the normal duration of the school year.
If you are apprenticed under contract, if you are not taking any classes except for some professional classes part-time, or classes by correspondence for perfecting your skills, seasonal agricultural classes, etc. answer "no".

9. Name and address of your school or university.
10. At what age did you stop attending school (including professional, technical, and university level schools)
_ _ years

11. Among the following diplomas, indicate all of those which you have:

a. General education

[] 1 Certificate of primary studies (C.E.P.) [Certificat d'études primaires]
[] 2 Elementary certification (B.E.P.C.) [Brevet d'études du premier cycle], (B.E.) or junior high certification (B.E.P.S.) [Brevet d'enseignement primaire supérieur]
[] 3 High school diploma (first part, junior year, second part), including the technical series, or superior certification [Brevet supérieur]
[] 4 Diplomas of higher education after the complete high school diploma (diplomas given in universities, diplomas at the end of studies at large professional schools [Grandes Ecoles], public or private, engineering schools, etc.).

b. Professional or technical education

[] 1 Exam at the end of artisan's internship
[] 2 Certificate at the end of a F.P.A internship
[] 3 Professional aptitude certification (C.A.P.) [Certificat d'aptitude professionnel]
[] 4 Professional certificate (B.P.) [Brevet professionel], Master's certificate
[] 5 Professional business certificate (B.E.C.) [Brevet d'enseignement commercial], Industrial certificate (B.E.I.), social (B.E.S.), hotel management (B.E.H.), agriculture (B.E.A.), etc.
[] 6 Student certified in the E.N.P. [Ecole nationale polytechnique] or from a technical high school, technical certificate or master technical certificate.
[] 9 Other professional diplomas given by private schools or public institutions.

Professional activity (for every person born before January 1st, 1954.
If you are currently out of work and if you are looking for some, go directly to question 17. If you are not working anymore, go directly to question 18.

Professional activity (for all persons born before January 1st, 1954)
[Applies to questions 12- 18]

12. Main profession: Indicate the profession or the occupation which you are currently practicing (even if you are still only an apprentice or if you are working by helping a member of your family in his/her work.) A woman who is taking care of her home should answer "no profession".

____

Be specific: Examples: auto repair mechanic, clothing producer, steel worker, draftsman, electrical engineer, grain broker, wine-producer, driver of large trucks, swine breeder, hairdresser, shorthand typist, etc.

13. Do you work without pay, by helping another person in your profession ( a member of your family, for example)?

[] 1 Yes
[] No

14. Do you practice your main profession declared in question 12 as:

[] 2 Owner, farmer, sharecropper.
[] 3 Member of a free-market profession
[] 4 Employer or self-employed: artisan, merchant, industrialist, etc. (self-employed, including managers of the S.A.R.L. [Société à responsabilité limitée] and people only working on commission).
[For any of the above options:]

Do you hire employees?
Do not count servants at home in your service. In agriculture, only count permanent paid workers.
[] Yes
How many?

[] 1 1 to 2
[] 3 3 to 5
[] 6 6 or more

[] 0 No

[] 5 Person working at home for one (or more) businesses.
[] 6 Apprenticed under contract.
[] 7 Paid worker : answer questions 15a, 15b or 15c below:

15a. If you are a worker, specify the qualification for your current job:

[] 1 Unskilled laborer or specialized laborer
[] 2 Specialized worker (OS1, OS2, ...).
[] 3 Skilled worker or highly qualified (P1, P2, P3...)

15b. If you are an employee of the state, a local town or a public service (E.D.F. "Electricité de France", S.N.C.F. "Société nationale des chemins de fer", etc.) or military by career, specify your rank:

____

Examples: administrative secretary, second-class stationmaster, typist, etc.
15c. If you are in a different situation, specify your position in the organization:

____

Examples: supervisor, workshop manager, department store head, etc.

16. Business (industrial or other) Farm, etc, which you are in charge of or where you work

a. Name (or corporate name) and address:

Name ____
Street ____
Number ____
City (for Paris, Lyon, Marseille, include the city neighborhood) ____
Department ____

b. Purpose of this business: ____
Be specific: Examples: whole-sale wine production, retail grocery store, manufacture of steel structures, cotton mill, highway transport of passengers, truck farmer, etc.
c. If you are not working at the address of the business, indicate the address of your usual workplace:

Street ____
Number ____
City (for Paris, Lyon, Marseille, include the city neighborhood) ____
Department ____

If, during your work, you must travel a lot (for example, train personnel of the S.N.C.F., bus drivers, etc.) indicate the place where you go ordinarily to do your work (train station, bus depot, etc.)
If you do not always do your work at the same place (for example, travelers on business), answer "variable".
If you work at home, indicate "at home".

17. If you are currently without work and if you are looking for some:

a. Have you already worked?

[] Yes
[] No

b. What is your occupation? ____
c. How long have you been looking for work?

[] 1 less than 3 months
[] 2 from 3 to 6 months
[] 3 from 6 months to less than a year
[] 4 a year or more

18. If you don't work anymore:

(You are, for example, retired from public service, a retired executive, old retired worker, former farmer, retired from business, etc.)
What is your main profession? ____

Means of Transportation Used
(for every person born before January 1st, 1962 who practices a professional activity or who is still in school)
19. Do you usually use a means of transportation in order get to your workplace or your classes?

[] No (work at home, distance made entirely by foot)
[] Yes: Indicate this (or these) means: for example: train, subway, bus, light rail, car, bicycle, moped, business vehicle, etc. If you usually use several means of transportation successively, indicate them in the order in which you use them beginning from your home:

First means of transportation ____
Second means of transportation ____
Third means of transportation ____

In (city) ____
On (date) 1968. ____
Signature of the respondent ____