Questionnaire Text

Questionnaire form view entire document: text image

11. Where were you born?

If born in Canada, mark the province then skip to question 13.
[] Nfid.
[] N.S.
[] Que.
[] Man
[] Atla
[] Yukon
[] P.E.I.
[] N.B.
[] Ont.
[] Sask.
[] B.C.
[] N.W.T.
Otherwise, mark country according to present boundaries
[] U.K.
[] Germany
[] Italy
[] Poland
[] Rep. of Ireland
[] U.S.A.

Questionnaire instructions view entire document: text image

11. If born in Newfoundland or Labrador, fill the circle for "Nfld." Whether or not you were born before Newfoundland became a province of Canada. If you are not sure of the country of your birth because of boundary changes, print in the space provided the name of the nearest city or district of birth. If you were born in one of the six counties of Northern Ireland (Antrim, Armagh, Down, Fermanagh, Londonderry, Tyrone), fill the circle for "U.K."; if born in any of the other counties, fill the circle for "Rep. of Ireland".