2. Relationship to head of household The head of household is the husband rather than the wife; the parent where there is one parent only with unmarried children, or any member of a group sharing a dwelling equally. Fill one circle only. [] Head of household [] Wife of head [] Son or daughter of head [] Father or mother [] Brother or sister [] Son-in-law /daughter-in-law [] Father-in-law/mother-in-law [] Brother-in-law/sister-in-law [] Grandchild [] Lodger [] Lodger's wife [] Lodger's child [] Nephew or nice [] Other, specify as uncle, aunt, employee, employee's wife, employee's child, partner ____

2. Relationship to head of household The head of household is the husband rather than the wife; the parent where there is one parent only with unmarried children, or any member of a group sharing a dwelling equally. Fill one circle only. [] Head of household [] Wife of head [] Son or daughter of head [] Father or mother [] Brother or sister [] Son-in-law /daughter-in-law [] Father-in-law/mother-in-law [] Brother-in-law/sister-in-law [] Grandchild [] Lodger [] Lodger's wife [] Lodger's child [] Nephew or nice [] Other, specify as uncle, aunt, employee, employee's wife, employee's child, partner ____

Please start with Question 1 by listing names. 1) Print the names of usual residents of this dwelling on June 1, 1971. a. Present in this dwelling b. Temporarily away Include persons with no other home. For definitions and order of listing see Instruction Booklet. Last name ____ First name ____ Initial ____ 2. Relationship to head of household The head of household is the husband rather than the wife; the parent where there is one parent only with unmarried children, or any member of a group sharing a dwelling equally. Fill one circle only. [] Head of household [] Wife of head [] Son or daughter of head [] Father or mother [] Brother or sister [] Son-in-law /daughter-in-law [] Father-in-law/mother-in-law [] Brother-in-law/sister-in-law [] Grandchild [] Lodger [] Lodger's wife [] Lodger's child [] Nephew or nice [] Other, specify as uncle, aunt, employee, employee's wife, employee's child, partner ____

2. Relationship to head of household The head of household is the husband rather than the wife; the parent where there is one parent only with unmarried children, or any member of a group sharing a dwelling equally. Fill one circle only. [] Head of household [] Wife of head [] Son or daughter of head [] Father or mother [] Brother or sister [] Son-in-law /daughter-in-law [] Father-in-law/mother-in-law [] Brother-in-law/sister-in-law [] Grandchild [] Lodger [] Lodger's wife [] Lodger's child [] Nephew or nice [] Other, specify as uncle, aunt, employee, employee's wife, employee's child, partner ____ 20. What is the highest grade or year of elementary or secondary school you ever attended? (See instruction booklet). [] No schooling [] Kindergarten [] Elementary or secondary (grade or year) [] 1 [] 2 [] 3 [] 4 [] 5 [] 6 [] 7 [] 8 [] 9 [] 10 [] 11 [] 12 [] 13

2. Relationship to head of household The head of household is the husband rather than the wife; the parent where there is one parent only with unmarried children, or any member of a group sharing a dwelling equally. Fill one circle only. [] Head of household [] Wife of head [] Son or daughter of head [] Father or mother [] Brother or sister [] Son-in-law /daughter-in-law [] Father-in-law/mother-in-law [] Brother-in-law/sister-in-law [] Grandchild [] Lodger [] Lodger's wife [] Lodger's child [] Nephew or nice [] Other, specify as uncle, aunt, employee, employee's wife, employee's child, partner ____ 20. What is the highest grade or year of elementary or secondary school you ever attended? (See instruction booklet). [] No schooling [] Kindergarten [] Elementary or secondary (grade or year) [] 1 [] 2 [] 3 [] 4 [] 5 [] 6 [] 7 [] 8 [] 9 [] 10 [] 11 [] 12 [] 13

3. Sex Fill one circle only. [] Male [] Female

4. Marital status Fill one circle only. [] Single (never married) [] Now married [] Widowed [] Divorced [] Separated

5. Mother tongue Language first spoken and still understood Fill one circle only [] English [] French [] German [] Italian [] Other (specify) ____

6. Month and year of birth Month [] January to May [] June to December Year of birth Decade Fill one circle only [] 186_ [] 187_ [] 188_ [] 189_ [] 190_ [] 191_ [] 192_ [] 193_ [] 194_ [] 195_ [] 196_ [] 197_ Actual year Fill one circle only [] 0 [] 1 [] 2 [] 3 [] 4 [] 5 [] 6 [] 7 [] 8 [] 9

11. Where were you born? If born in Canada, mark the province then skip to question 13. [] Nfid. [] N.S. [] Que. [] Man [] Atla [] Yukon [] P.E.I. [] N.B. [] Ont. [] Sask. [] B.C. [] N.W.T. Otherwise, mark country according to present boundaries [] U.K. [] Germany [] Italy [] Poland [] Rep. of Ireland [] U.S.A.

12. If born outside Canada, in which period did you first immigrate to Canada? [] Before 1931 [] 1931-1945 [] 1946-1950 [] 1951-1955 [] 1956-1960 [] 1961-1964 [] 1965 [] 1966 [] 1967-68 [] 1969 [] 1970 [] 1971