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Fourth Census of Canada, 1901

Schedule No.1 Population

____ Province

____ District
____ S. District number
____ Polling sub-division
____ City, town, village, township or parish

____ Page

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

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

____ Profession, occupation, trade, or income of living of each person
____ 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)

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)

6. Infirmities (If the infirmity dated from childhood add "from childhood")

____ Deaf and dumb
____ Blind
____ Unsound mind