Questionnaire Text

Questionnaire form view entire document: text image

Only for women 15 years of age and older

36. When was your last son or daughter born alive?

____ Month

____Year

Questionnaire instructions view entire document: text image

Question 36

Mark the months using the first three letters of each one. [These instructions refer to a graphic of question 36 on the census form. An arrow points to the boxes for "Month".]