____ Civil Parish or Township
____ City, Town, Village, or Hamlet
____ Sanitary District
____ Street, Square, etc., or Road
____ Name or No. of House
____ Name of Occupier
This paper must, in compliance with the Act, be filled up by the occupier of person in charge of the dwelling.
If a house be let or sublet to separate persons or families each occupier must make a return for his portion of the house upon a separate schedule.
Before filling up the paper all the instructions printed in the heading and on the back of the schedule should be carefully read.
This paper will be called for on Monday, April 6th, by the appointed enumerator, and it is necessary that you should have the answers written in the proper columns early on the morning of that day in order that he may not be delayed. It will be his duty, under the Act, to complete the return if defective, and to correct it if erroneous. Any person authorized by you may write in the particulars if you are unable to do so yourself.
Person who refuse to give information or who willfully give false information as to any of the required particulars, are liable, on summary conviction before Justices, to a fine of five pounds.
The return is required to enable the Local Government Board to complete the Tenth Census. 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 other purposes than those of the census.
No persons absent on the night of Sunday, April 5th, to be entered here; except those who may be travelling or out at work during that night (and are not elsewhere returned), and who return home on Monday, April 6th.
(Write after the name of the head of the family, the names of his wife, children, and other relatives, then visitors, boarders, and servants.)
____ Name and surname
State whether head, or wife, son, daughter, or other relative, visitor, boarder, or servant.
____Relation to head of family
Write either "married", "widower", "widow", or "single", opposite the names of all persons except young children.
____Condition as to marriage
Write "M" opposite Males and "F" opposite Females.
For infants under one year, state the age in months, writing "under 1 month", "1 month", "2 months", etc.
____ Age last birthday
Before filling up columns 6, 7, 8, and 9, you are requested to read carefully the special instructions printed on the other side.
____ Profession and occupation
 2. A person following several distinct occupations must state each of them in the order of their importance.
 3. Person who have retired for their profession, business, or occupation must state their former calling, with the addition of the word "retired" as "retired farmer", "retired grocer", "retired Blacksmith".
 4. The occupations of women and children, if any, are to be stated as well as those of men.
 5. A cross must be made in column 7, headed "employer" when the person is a master, employing under him workers in his trade or industry, in column 8, headed "employed", when the person is working in a trade or industry under a master, and in column 9, headed "neither "employer nor employed", when the persons neither employs other workmen in his trade or industry, nor works for a master, but works on his own account. Married women assisting their husbands in their trade or industry are returned as "employed".
These three columns, 7, 8, and 9, refer only to employment in trades and industries, and not to the employment of domestic servants.
 2. Persons serving in the army, the navy, or the civil service should state their grade and the branch of service to which they belong.
 3. Clergyman of the Church of England should return themselves as clerk in Holy orders or as Rector, Vicar, Curate of ____, and should not use the indefinite term clerk without further specification. Priests and ministers of other religious communities must state to what community they belong - as "Roman Catholic Priest", "Wesleyan Minister". Local or occasional preachers must return their ordinary occupation, but may also add the fact of their being preachers.
 4. Members of the legal profession should return themselves as barristers or solicitors, as the case may be. Law clerks should return themselves as barrister's clerk or solicitor's clerk. Articled clerks in solicitors' offices should be so described.
 5. Members of the various branches of the medical profession should state whether they are duly registered Practitioners, and whether they practice as physician, surgeon, general practitioner, dentist, etc.
 6. Professors, teachers, etc., should state the branch of science or art or knowledge which they follow. Artists also should state the art they cultivate.
 7. Students of theology, law, medicine, or other branches of knowledge should return themselves as such.
 8. Merchants, brokers, agents, etc., must state the particular branch of commerce in which they are engaged - as "East India Merchant", "stock broker", "cotton broker".
 9. Sons or other relatives of farmers employed on the farm should be returned as "farmer's son", "farmer's brother", etc.
 10. Agricultural Laborers, Shepherds, and others employed on farms must return themselves as such. The term "laborer" must not be used by itself to describe an "Agricultural Laborer". Men employed on farms and living in the farmer's house must return themselves as Farm Servants but this term should not be used for domestic servants in a farm house.
 11. Shopmen and shop women should state in what branch of business they are employed - as, "draper's assistant", "milliner's shop woman".
 12. such terms as manager, foreman, superintendent should never be used without stating the special branch of trade in which the person is employed.
 13. Domestic servants should state the nature of their service, adding in all cases "domestic servant". Examples "coachman - domestic servant"; "gardener - domestic servant", "cook - domestic servant".
 14. The vague term "engineer", which might equally designate a civil engineer or and engine-driver, or an engine maker, is never to be used alone. Civil and mining engineers should describe themselves as such. Engine and machine makers should specify the precise branch of the trade in which they are employed - as, "steam-engine maker - fitter". engine drivers, stokers, firemen should state whether they drive or stoke railway engines, ship's engines, or stationary engines, or whether they are furnace stokers - as "stoker on steam ship", "railway engine driver", "gas stoker", "furnace stoker at potteries".
 15. Artisans, mechanics, and workers in manufactories generally, should state distinctly not only the general name of the industry in which they are employed, but the particular branch of the industry in which they are engaged, and also the material in which they work, if it be not implied in the name, and if such name be common for several industries - as, "brass founder", "silk throwster", "watchmaker -finisher", "printer compositor". Such terms as founder, finisher, throwster, etc. common to many industries must not be used without more precise descriptions.
 16. Weavers, Spinners, etc., should invariably state the material in which they work - as, "Cotton-spinner", "Silk Weaver", etc.
 17. Miners should always state the kind of mine in which they work - as, "coal miner", "lead miner". The term "miner" should never be used alone.
 18. Laborers, porters should specify the nature of their employment - as, "railway porter", "agricultural laborer", "bricklayer's laborer", "laborer in ship yards", "general laborer". The term "laborer" should never be used alone.
 19. Persons following no profession, trade, or calling, but deriving their income from land, houses, dividends, or other private sources, should return themselves as "Living on their own means". Such indefinite terms as "Gentleman", "Esquire", etc., should not be used.
Opposite the names of those born in England and Wales, 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 Country; and if also a British subject, add "British Subject", or "Naturalized British subject", as the case may be.
 2 Blind,
 3 Lunatic, imbecile or idiot