Questionnaire Text

Questionnaire form view entire document:  text  image

[Questions 5-27 were asked of residents of the housing unit, per question 4]


6. Date of birth

Day _ _
Month ____
Year 1 _ _ _

Questionnaire instructions view entire document:  text  image

Important: Individuals not residing in the dwelling where they spend 16 March 1981, at 00:00 hours, end the filling-in of the questionnaire here.
[Questions 5-27 were asked of residents of the housing unit, per question 4]


Question 6 - Date of birth

The indication of the year is of extreme importance.

Note: This question cannot be left blank, (day-month-year).