Fourth Census of Canada, 1901
Schedule No.1 Population
____ District
____ S. District Number
____ Polling sub-division
____ City, town, village, township or parish
Nominal Return of Living Persons by Enumerator
Numbered in the order of visitation
____ Dwelling House number
____ Family or Household number
1. Personal Description
____ Name of each person in family or household on March 31, 1901
____ Sex
____ Colour
____ Relationship to head of family or household
____ Single, married, widowed or divorced
____ Month and date of birth
____ Year of birth
____ Age of last birthday
____ Sex
____ Colour
____ Relationship to head of family or household
____ Single, married, widowed or divorced
____ Month and date of birth
____ Year of birth
____ Age of last birthday
2. Citizenship, Nationality and Religion
____ Country of place of birth (If in Canada, specify Province or Territory)
____ Year of immigration to Canada
____ Year of naturalization
____ Racial or Tribal origin
____ Nationality
____ Religion
3. Principal Profession or Trade
____ Year of immigration to Canada
____ Year of naturalization
____ Racial or Tribal origin
____ Nationality
____ Religion
____ Profession, occupation, trade, or income of living of each person
____ Living on own means
____ Employer
____ Employee
____ Working on own
____ Living on own means
____ Employer
____ Employee
____ Working on own
4. Wage Earner
____ Working at trade in factory or in home
____ Mostly employed at trade in factory
____ Mostly employed at trade in home
____ Mostly employed in other occupation than trade in factory or home
____ Earnings from occupation or trade
____ Extra earning (from other than chief occupation or trade)
____ Mostly employed at trade in factory
____ Mostly employed at trade in home
____ Mostly employed in other occupation than trade in factory or home
____ Earnings from occupation or trade
____ Extra earning (from other than chief occupation or trade)
5. Education and Language of each person five years of age and over
____ Months at school in year
____ Can read
____ Can write
____ Can speak English
____ Can speak French
____ Mother tongue (if spoken)
____ Can read
____ Can write
____ Can speak English
____ Can speak French
____ Mother tongue (if spoken)
6. Infirmities (If the infirmity dated from childhood add "from childhood")
____ Deaf and dumb
____ Blind
____ Unsound mind
____ Blind
____ Unsound mind