Questionnaire Text

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For each occupied dwelling, mobile unit or provisional premises a separate form A should be completed.

____ Voidvoship
____ Town
____ Community
____ Locality

____ Name
____ Type

____ Street (square, circus, etc.)
____ No. of real estate
____ No. of dwelling

____ Number of attached additional forms A
____ No. of census district
____ Successive no. of building in census district