Questionnaire Text

Questionnaire form view entire document:  text  image

Please start with Question 1 by listing names.
1) Print the names of usual residents of this dwelling on June 1, 1971.
a. Present in this dwelling
b. Temporarily away

Include persons with no other home.
For definitions and order of listing see Instruction Booklet.
Last name ____
First name ____
Initial ____


2. Relationship to head of household

The head of household is the husband rather than the wife; the parent where there is one parent only with unmarried children, or any member of a group sharing a dwelling equally.
Fill one circle only.
[] Head of household
[] Wife of head
[] Son or daughter of head
[] Father or mother
[] Brother or sister
[] Son-in-law /daughter-in-law
[] Father-in-law/mother-in-law
[] Brother-in-law/sister-in-law
[] Grandchild
[] Lodger
[] Lodger's wife
[] Lodger's child
[] Nephew or nice
[] Other, specify as uncle, aunt, employee, employee's wife, employee's child, partner ____

Questionnaire instructions view entire document:  text  image

1. It is very important that all usual members of the household (including those temporarily away on vacation, business, at school, etc., as well as those with no home elsewhere) be listed. When entering names, follow the order shown below to ensure that all members of the same family group are enumerated together:
1 Head of household
2 Wife of household head
3 Unmarried children in order of age, eldest first
4 Married children and their families
5 Other relatives and their families
6 Lodgers and their families
7 Employees and their families
8 Other members of the household.


2. Include as "son or daughter" a stepchild or an adopted child, as well as foster children or wards for whom no pay is received. An unrelated foster child or ward for whom pay is received should be marked "Lodger". Be sure to (i) fill the "Other" circle, and (ii) write in the actual relationship to the household head for all persons for whom no marking position has been provided.