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Census for Norway
1st December, 1910
[The National Coat of Arms]
Form 1: Family list no. ______
___________________ town. Ward no. _______
___________________street, no. ____

Questions about the domicile/flat:

Is the domicile inhabited by the household situated in a front house, attached building, in-between building, back building, watch house, etc.?
On what floor is the domicile? _______

Number of rooms taken by the household, (of course including servants' rooms) as well as the number of persons who stayed there during the night of December 1st.
a) In the basement
b) On the floors
c) In the attic or loft.

Number of kitchens? ________
If the kitchen is used jointly by two or more families, write "1/2", "1/3" etc. Where no kitchen belongs to the family, write "0".

Is there a separate bathroom in the flat?
[] Yes
[] No
____

or if a common bathroom for two or more families write "1/2", "1/3", etc.

Page 1

Census for Norway
1st December, 1910
[The National Coat of Arms]
Form 1: Family list no. ______
___________________ municipality. Ward no. _______
Farm no. ________, sub-farm no. ____
The name of the domicile (farm, place) _______

This form is filled {by the relevant housefather / housemother or other relevant person or if necessary} or ordered filled by the enumerator who is responsible for the ward. Instructions are found on page 4 of this form. Questions about the inhabited houses:

Are there any auxiliary or out-houses which were used for residence on the night of December 1st?
[] Yes
[] No


If in the confirmative, ask: How many _____ and what kind (retirement house, servants building, sauna, washhouse, barn, stable, etc.)?

The 2nd, 3rd, and 4th page (inside) contained schematically the following 14 fields for up to 20 persons.

House list with the number of people by December 1st, 1910

Each person's number _______

The persons' names. (First names and other names) _______
Listed by household and house. A child who is not yet given a name is noted as "unbaptized boy" or "unbaptized girl".

Gender:
[] m. Male
[] k. Women

Whether living (Cf remark 4):
[] b. In this place
[] mt. Temporarily present
[] f. Temporarily absent
For those who were temporarily present: usual place of residence ______

For those who were temporarily absent: likely place of staying December 1st ______

Position in family:
[] hf. Housefather
[] hm. Housemother
[] s. Son
[] d. Daughter
[] tj. Servant
[] fl. Lodger belonging to the family
[] el. Single lodger
[] b. Visitor

Marital status (cf remark 6):
[] ug. Unmarried
[] g. Married
[] e. Widow(er)
[] s. Separated
[] f. Divorcees

9a. Occupation and position. Also the specific occupations of the housemother or children. Note accurately and specifically trade or discipline which the person performs or work in, so that this person's position in the occupation can be understood (e.g., tenant farmer, shoemaker apprentice, pulp mill worker). If someone has several occupations, note these, first the main occupation. (Cf also remark 7).
9b. If someone is unemployed on Census day, put the letter: "I".

10. Birthday and birth year ________

11. Birthplace. (For those born in the same municipality as that enumerated, write the letter ("t."), for others write the name of the municipality or parish) or the name of the town. For those born abroad: write the name of the country (or the place) _______

12. Citizenship. [nationality]. (For Norwegian citizens write the letter "u."; for other write the name of the relevant state _________

13. Religious affiliation. (For members of the Norwegian state church write the letter "s."; for others note the name of the relevant religious society, or if relevant, "Withdrawn, no affiliation" __________

14. Mentally ill, deaf or blind. Were any of the listed persons:
[] d. Deaf
[] b. Blind
[] s. Mentally ill
[] aa. Feeble-minded (viz. from birth or earliest childhood)

15. Ethnicity*:
[] n. Norwegian
[] lf. Sami resident
[] ln. Sami nomadic
[] f. Finnish, "kvænsk"
[] b. mixed

16. Language spoken in the person's home*:
[] n. Norwegian
[] l. Sami
[] f. Finnish, "kvænsk"

[*] Fields 15 and 16 are filled for all domiciles where any person is of Sami, Finnish ("kvænsk") or mixed ethnicity.

Summary of the list on the previous pages.
The total number of persons who were present in this domicile December 1st was _____ (Include all persons listed except those preliminarily absent [field 6.])
The total number of persons who were present in this domicile December 1st was _____ (Include all persons listed except those preliminarily present [field 5.])

1 The person's sequence number in the house list on the previous pages.

Page 6

5. Supplementary questions about the domicile etc.
1. How many of the rooms in the domicile (cf the form's 1st page) are used for:

a. Servants' rooms? _____
b. For lodgers? _____

2. What rent is paid for the domicile? ______

{Special question for Kristiania (Oslo): Do any of the persons on the form belong to the Garrison Parish, and what are their numbers in the list?}