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Census of Ireland, 1911

General instruction
Heads of families are requested to insert their particulars specified on the other side, in compliance with the Census (Ireland) Act, 1910, 10 Edw. VII., and 1 Geo. V. c. 11.
If a house be let or sub-let to separate families, or to lodgers (not boarders), each head of a family or lodger must make a return for his portion of the house upon a separate form.
Hotel and lodging-house keepers and stewards of clubs, are to give a return of all persons who arrive at their establishment on Monday, the 3rd of April, and who had not been enumerated elsewhere.
This paper will be called for on Monday, April 3rd, or as soon after as possible, between the hours of half-past eight in the forenoon and six in the afternoon, by the appointed enumerator, and it is desirable that the required particulars be written in the proper columns by the morning of that day, in order that his progress may not be delayed. The enumerator will assist such persons as may not be able to fill the form themselves.
No question shall be put by the enumerator for the purpose of obtaining information other than the information required by the forms and instructions issued under the authority of the Census Act.
The facts will be published in general abstracts only, and strict care will be taken that the returns are not used for the gratification of curiosity, or for any other object than that of rendering the Census as complete as possible. If any person employed in taking the Census communicates without lawful authority any information acquired in the course of his employment, he is liable to punishment under the Official Secrets Act, 1889.
Attention is directed to the Extracts from the Census Act printed on this form; and also to the direction at head of each column.

William J. Thompson, Registrar- General
Edward O?Farrell
Daniel S. Doyle


J. B. Dougherty, Dublin Castle, 8th December, 1910.

Form A
Return of the members of this family and their visitors, boarders, servants, etc., who slept or abode in this house on the night of Sunday, the 2nd of April, 1911.

Name and surname
No persons absent on the night of Sunday, April 2nd, to be entered here; except those (not enumerated elsewhere) who may be out at work or travelling, etc., during that night and who return home on Monday, April 3rd. Subject to the above instructions, the name of the head of the family should be written first; then the names of his wife, children, and other relatives; then those of visitors, boarders, servants, etc.
____ Christian name
____ Surname

Relation to head of family
State whether head of family or wife, son, daughter, or other relative etc., visitor, boarder, servant, etc.
Relation to head of family ____

Religious profession
State here the particular religion, or religious denomination, to which each person belongs.
Members of Protestant denominations are requested not to describe themselves by the vague term Protestant, but to enter the name of the particular church, denomination, or body to which they belong.
Religious profession ____

State here whether [the respondent] can read and write, can read only, or cannot read.
[] Read and write
[] Read
[] Cannot read

Age (last birthday) and sex
Insert age opposite each name: The ages of males in column 6, and the ages of females in column 7. For infants under one year state the age in months, as under 1 month, 1 month, 2 months, etc.
_ _ Ages of males
_ _ Ages of females

Rank, profession, or occupation
State the particular rank, profession, trade, or other employment of each person. Children or young persons attending a school, or receiving regular instruction at home, should be returned as Scholars. No entry should be made in the case of wives, daughters, or other female relatives solely engaged in domestic duties at home.
Before filling this column you are requested to read the instructions on the other side.
Rank, profession, or occupation ____

Particulars as to marriage

Whether married, widower, widow, or single

[] Married
[] Widower
[] Widow
[] Single

State for each married woman entered on this schedule the number of completed years the present marriage has lasted. If less than one year, write under one

Years the present marriage has lasted _ _ _ _

Children born alive to present marriage. If no children born alive, write none in column 11.

____Total children born alive
____ Children still living

Where born
If in Ireland, state in what county or city; if elsewhere, state the name of the country.
Where born ____

Irish language
Write the word Irish in this column opposite the name of each person who speaks Irish only, and the words Irish and English opposite the names of those who can speak both languages. In other cases no entry should be made in this column.
[] Irish
[] Irish and English

If deaf and dumb; dumb only; blind; imbecile or idiot; or lunatic
Write the respective infirmities opposite the name of the afflicted person.
Infirmities ____