Census of Population of Ireland, 1971
Census Day: Sunday 18 April, 1971
Central Statistics Office, Dublin
Form A strictly confidential. To be filled in by the official enumerator:
_____ County or Co. Borough
_____ D.E.D. or Ward
_____ Street, etc., and number of house
 1 Private household
 2 Non-private household
Number of persons in household:
1. Name and surname_____
2. Sex _____
3. Relationship to head of household_____
5. Usual residence one year ago______
6. Place of birth____
7. Date of birth
8. Marriage ____
[Questions 9 and 10 must be answered by married women only]
9. Month and year of present marriage
10. Number of children born alive to present marriage___
12. Ability to speak the Irish language____
13. Transport to work or school
[Questions 14-18 are be completed for each person aged 14 years or older]
14. Principal occupation ____
15. Employment status_____
16. Employer and employer's business______
If self employed, state nature of business in which engaged
If a farmer, state the area and total ratable valuation of the farm on which working
If a farm worker, state the area of the farm on which working
If out of work, state the name, address and nature of the business of last employer.
17. Full-time education received:
State age at which full-time education ended____
Vocational, technical, or commercial: ___ years
University or higher technical: ____ years
18. Scientific or technological qualifications
[The following questions should be answered in respect of each private household and of the house, flat or rooms occupied by that household. These questions need not be answered in respect of private households living in caravans or other mobile dwellings.]
19. Agricultural holdings _____
State the area and ratable valuation of all agricultural holdings (if any) in the state, of which persons usually resident in the household are the rated occupiers. Land held under the eleven months system or in conacre or in commonage should not be included.
Area in statute acres _____
Valuation (land and buildings): ______ pounds
20. Nature of occupancy of house, flat or rooms
 Rented unfurnished, other than from local authority
 Rented furnished or part furnished
 Being acquired from local authority under a purchase or vested cottage scheme
 Owner occupied (including cases where loan or mortgage repayments are being made)
 Occupied free of rent (caretaker, company official, etc.)
If the house, flat or rooms are rented, state the rent (inclusive of rates and ground rent) and strike out periods which do not apply.
Pounds _______ (per week, month or year)
Pence _______ (per week, month or year)
If the house, flat or rooms are rented unfurnished other than from a local authority, did the letting commence before 1961?
22. Year in which house was built
 Before 1860
 Between 1860 and 1899 inclusive
 Between 1900 and 1918 inclusive
 Between 1919 and 1940 inclusive
 Between 1941 and 1960 inclusive
 1961 or after
23. Rooms ____
24. Water supply
 Water tap, outside the building only, connected to public main
 Water tap, inside the building, connected to private source
 Water tap, outside the building only, connected to private source
 No piped water supply
25. Bath or shower:
Has the household the use of a fixed bath or shower?
If "Yes", is this bath or shower shared with another household?
26. Sanitary facilities
 Dry closet
 Chemical closet
 No toilet or closet
Is the toilet or closet inside the building?
Is the toilet or closet shared with another household?
Is an electricity supply laid on to the dwelling?
28. Motor cars_____