Check the box which applies to you.
Write in only one number per box.

Section to be filled out by the INSEE

1. Name
_____ Last name
_____ First name

2. Address ______

3. Sex

For people passing through (see page 3 of printout no. 1) address of the usual residence:
Street number _____
Street (place name) ____
Zip code _ _ _ _ _
City ____

Questions 9 through 24 are only addressed to people 14 years old or more
[Questions 9-24 were asked only of persons 14 years or older.]

9. What level of study have you completed?

Thank you for your participation
In (city) ____, the _______ 1999
Signature of the respondent ______

Form number 1A

Housing form to be filled out for every dwelling, occupied or not
Population Census 1999
French Republic

Section to be filled out by the census agent
Number of the census district _ _ _ _ _
Location of the building in the district _ _ _
Location of the dwelling in the building _ _

Mayor's stamp
Fill out the four pages legibly

1. First and last name of the occupant: ______

2. Address of the dwelling
Number ____
Street (or place name) ______
County _ _
City (for Paris, Lyon, Marseille, specify the city neighborhood) ____

3. Location of the dwelling in the building (if the former is comprised of two dwellings or more)

General Recapitulation

[Illegible note at bottom of the page]

People living in the dwelling
Each person normally living in a dwelling, even if he/she is absent at the time of the census must be recorded either in list A or list B (see example at the bottom of the page). Don't forget young infants.

List A
Permanent occupants of the dwelling

Record the people living in the dwelling in the right-hand chart including yourself and the people absent on the date of the census (people on business or leisure trips, sick people staying short-term at the hospital or in a clinic, etc), not including people who find themselves in a situation described in list B below.
Special cases. Also record:

• Employees in your service, apprentices, young babysitters who are living at your house;
• Sub-letters or people you are hosting, occupying one part of your dwelling, except if it is a section completely separate constituting then another dwelling.

For each person appearing in this list, fill an individual questionnaire.

[The following questions appear in a table with space for 11 individual responses.]

Last Name ______
Write in capital letters
Example: ALLARD: spouse MAURIN

First name ______

Kinship or relationship ______ to the person recorded on line 1;
write, for example: wife (or husband, partner, son, daughter, father, mother, grandson, daughter-in-law, nephew, friend, subletter, etc.)

[Underneath the three questions above]

Section reserved for students living here only for their studies and having their family residence elsewhere

• If you are hosting a student during the school year, note below (on the line corresponding to him/her) the address of his/her family residence.
• If you yourself are a student living here for your studies, write below (on the line corresponding to you) the address of your family residence.

List B
People who are a part of your household but who are currently in one of the following situations:

Record in the chart on the right the people who are in the following situations:

• Children living in a boarding school;
• Children in the care of another parent (following a divorce for example);
• Students living somewhere else during the school year (in a home, in a university dormitory, in an independent dwelling or a room in the city;
• Conscript servicemen and women;
• Servicemen serving outside of France;
• Workers living in another home;
• Elderly people living in a retirement or nursing home;
• People being hospitalized long-term;
• People living in another community but spending a part of the year in your dwelling

Do not fill out any individual form for these people; their forms will be filled out in the place where they usually live.
[The following questions appear in a table with space for 3 responses]

______ Last Name

______ First name

______ Kinship or relationship with the person recorded on line 1 of list A

Date of birth

Is this person a student?

Name and address of the establishment (or address of the dwelling)

• The Maurin household lives in Saint-Malo. M. Maurin and his wife have four children of which only one, Christophe, is at home all week.
• The Maurin household rents a room of his dwelling to a student, Yves Couedec, whose family lives in Roscoff.
• One of the Maurin sons, Laurent, is carrying out his military service in the middle of France.
• One of the Maurin's daughters, Sophie, lives in a student home in Paris.
• The other daughter, Nathalie, is a student in the university of Rennes, city where she rents a room.

List A

Four individual forms.

List B

No individual forms.

People passing through
The people who are at your home at the time of the census but who usually live somewhere else (with parents, friends, etc.) should not be recorded on either of the two lists.

Special case: If a person is absent from his home during the entire length of the census and if someone else cannot answer census questions in his/her place at his/her home

General Characteristics of the Building

1. Type of dwelling

2. Year of the completion of the construction of the house or building

4. Surface space of the dwelling

10. Drainage of water used

13. Garage - Stall - Parking lot

15. Is the dwelling the center of a farm?