Questionnaire Text

Questionnaire form view entire document:  text  image

6. Place of birth
If the person in question was not born in Haiti, write down in capital letters the name of the foreign country.
________ Municipality [commune]
[] 1 City _ _ _ _ _
[] 2 Rural section

________ Foreign country
Questionnaire instructions view entire document:  text  image

Column 6- Place of Birth: If the person in question was born in Haiti, write the name of the municipality in capital letters and write an 'x' in the town or rural section, depending on whether the individual was born in one of these geographical subdivisions. For example:
For person born in the town of Cayes:

CAYES

Municipality

1. [X] Town
2. [ ] Rural Section


If the person in question was not born in Haiti write the name of the foreign country in capital letters.

For example: A person born in New York:

Foreign country
NEW YORK (USA)