____Parish or Township
____City, Town, Village, or Hamlet





____Street, Square, etc. or Road





____Name or No. or House




____Name of Occupier

(No persons absent on the night of Sunday April 3rd, to be entered here; except those who may be traveling or out of work during that Night, and who return home on Monday, April 4th)

State the Name of the:
____ Head of the Family
____ Wife
____ Children
____ Other Relatives
____ Visitors
____ Boarders
____ Servants

[] Head
[] Wife
[] Children
[] Other relatives
[] Visitors
[] Boarders
[] Servants

Write opposite the Names of all Persons except Young Children.

[] Married
[] Widower
[] Widow
[] Unmarried

Write "M" opposite Males, and "F" opposite Females

[] M
[] F

For Infants under One Year, state the Age in Months, writing "Under 1 Month," "1 Month," "2 Months," etc.

____ Age

A person following more distinct occupations than one, should insert each of them in order of their importance.

(a) The Titles of peers and other persons of rank to be inserted, as any important Office they may hold.

(b) Members of Parliament, Magistrates, Alderamen, and other important public Officers, to state their profession or occupation, if any, after their official rank or title.

(c) All persons serving in the Army and Navy, to state their rank and the branch to which they belong. Officers to state whether on the Active or Retired List; Chelsea, Greenwich, and other Pensioners, to be so designated.

(d) All persons in the Civil Service to state their rank, and the department or branch to which they belong; those retired or superannuated to be so designated.

(e) Ministers of religion: CLERGYMEN of the Church of England to return themselves as "Rector of --," Vicar of--," Curate of --," etc., or "without cure of souls." They are requested not to employ the indefinite term "Clerk." Roman Catholic Priests, and Ministers of Foreign Churches, to return themselves as such, and to state the name of the church or chapel, if any, in which they officiate. Dissenting Ministers to return themselves as "Independent Minister of -- Chapel," "Wesleyan Minister of -- Chapel," etc. Local or occasional preachers must return their ordinary occupations ; but may add "Local Methodist preacher," etc., etc.

(f) Legal Profession: Barristers to state whether or not they are in actual practice. The designation Solicitor to be confined to those whose names are actually on the Roll. Barristers' Clerks are so to return themselves. Clerks in Solicitors' Offices should state whether they are Solicitors Managing, Articled, or General Clerk. Officers of any Court to state the name of the Office, and the name of the Court.

(g) Members of the Medical Profession to state whether they practice as Physician, Surgeon, Dentist, Oculist, General Practitioner, Assistant, etc., or are "not practicing." They must also state the University or other Society of which they are Graduates, Fellows, or Licentiates.

(h) Professors, Teachers, Public Writers, Authors and Scientific MeN: to state the particular branch or Science or Literature which they follow; Artists, the art which they cultivate. Graduates should enter their degrees in this column.

(i) Students of Theology, Law, or Medicine, and Undergraduates of any University, to be so returned.

(j) Scholars: Children or young persons attending a School, or receiving regular instruction at home, to be returned as "Scholars".

(k) Farmers to state the number of acres occupied, and the number of men, women, and boys employed on the farm at the time of the Census. -- Example:"Farmer of 317 Acres, employing 8 Labourers and 3 Boys." Sons or Daughters employed at home or on the farm should be returned--"Farmer's Son," "Farmer's Daughter." Men employed on the farm and sleeping in the Farmer's house must be described in the schedule as Farm Servants.

(l) Agricultural Labourers, Shepherds, and other employed on Farms, but not living in the Farmer's house, must be described as Agricultural Labourers, Shepherds, etc.

(m) Persons engaged in commerce as Merchants, Brokers, Agents, etc., to state in all cases the particular branch of Commerce in which they are engaged or the staple in which they chiefly deal. -- Examples: "East India Merchant," "Member of -- Stock Exchange," "Cotton Broker." Commercial Clerk, Commercial Traveller, Shopman -- always to add in what branch of business.

(n) In trades, manufactures or other Business, Masters must, in all cases, be so designated.--Example: "Carpenter--Master, employing 6 men and 2 boys; inserting always the number of workpeople in their employ at the time of the Census. In the case of Firms, the number of persons employed should be returned by the senior or some one partner only.

(o) Workers in Manufactures, and generally in the Mechanical Arts, should distinctly state the particular Branch of Work, and the Material, if they are not implied in the names, as in Brass-founder, Silk-throwster. Where the trade is much sub-divided, both trade and branch are to be returned, thus -- "Watchmaker--Finisher;" "Printer--Compositor."

(p) Miners should state the description of Mine in which they work. --Examples: "Coal Miner," "Iron Miner," Lead Miner," "Tin Miner," "Copper Miner," etc. The term Miner should never be used alone.

(q) Engineers: Civil Engineers and Mining Engineers to be so described. Workmen employed in works or factories are to be distinctly described. --Examples: "Engine Smith at Factory," "Engine Fitter at Works." Engine Drivers, Stokers, and Firemen to be described in connection with the manufactory, railway, steam-vessel, etc., in which they are employed. --Examples: "Railway Engine Driver," "Stoker in Cotton Factory," "Engineer" alone is not to be used.

(r) Artisans and Mechanics should invariably sate the particular branch of mechanical art or business in which they are employed. --Examples: "Model Maker--Engine," "Wire Worker--Telegraph."

(s) Weaver. --"Silk," "Wool," "Worsted," "Cotton," etc., should always be written before this general term, so as to express distinctly the material which he weaves; thus, "Silk Weaver."

(t) Domestic Servants should be described according to the nature of their service, adding in all cases "Domestic Servant." --Example: "Coachman-Domestic Servant;" "Gardener-Domestic Servant;" "Cook-Domestic Servant."

(u) Messengers, Porters, Laborers, to be described according to the nature of their employment. -- Examples: "Railway Porter," "Bricklayer's Laborer," "Laborer in Iron Works," "General Laborer." The term Laborer should never be used alone.

(v) Persons ordinarily engaged in some industry, but Out of Employment at the time of the Census, should be so described: as "Coal Miner, unemployed;" "Printer, unemployed."

(w) Persons following no profession, trade or calling, and holding no public office, but deriving their incomes chiefly from land, houses, dividends, interest of money, annuities, etc., may describe themselves accordingly. The indefinite terms Gentleman, Esquire, are not to be used. Persons who have retired from business to be entered thus--"Retired Farmer," "Retired Grocer."

(x) Women and children: The occupation of those who are regularly employed from home, or who follow any business at home, is to be distinctly recorded.

Rank, Profession, or Occupation? ____

Opposite the Names of those born in England, write the County, and Town or Parish. If born in Scotland, Ireland, the British Colonies, or the East Indies, state the Country or Colony. If born in foreign parts, write the particular State or County; and if also a British Subject, add "British Subject," or "Naturalized British Subject," as the case may be.
____Where born

Write the respective Infirmities opposite the name of the afflicted Person; and if so from Birth, add "from Birth."

[] Deaf-and-Dumb
[] Blind
[] Imbecile or Idiot
[] Lunatic
[] from Birth