Questionnaire Text

Questionnaire form view entire document:  text  image
Part C: Anyone 15 years and older is requested to fill-in both pages


[Questions 14-38 were asked of people 15 years or older.]


19. Did you ever marry?

[] 1. I did not marry
[] 2. I married once in 19 _ _
[] 3. I married more than once

[] The last time in 19_ _
[] The first time in 19_ _

Questionnaire instructions view entire document:  text  image
9. Question 19

19. Have you ever been married?

[] 1 I have never been married
[] 2 I was married once in the year 19 _ _
[] 3 I was married more than once
The last time in 19 _ _
The first time in 19 _ _

Those married more than once will mark an X in the box of answer 3 and also will write the year of the last marriage and the year of the first marriage.