CENSUS OF ENGLAND AND WALES, 1911
Number of Schedule 13
(To be filled up by the Enumerator after collection.)
Before writing on this Schedule please read the Examples and the Instructions given on the other side of the paper, as well as the headings of the Columns. The entries should be written in Ink.
The contents of the Schedule will be treated as confidential. Strict care will be taken that no information is disclosed with regard to individual persons. The returns are not to be used for proof of age, as in connection with Old Age Pensions, or any other purpose than the prepartion of Statistical Tables.
1. NAME AND SURNAME
of every Person, whether Member of Family, Visitor, Boarder or Servant, who
(1) passed the night of Sunday, April 2nd, 1911, in this dwelling and was alive at midnight, or
(2) arrived in this dwelling on the morning of Monday, April 3rd, not having been enumerated elsewhere.
No one else must be included.
(For order of entering names see Examples on back of Schedule).
2. RELATIONSHIP to Head of Family
State whether “Head” or “Wife,” “Son,” “Daughter,” or other Relative, “Visitor,” “Boarder,” or “Servant.”
AGE (last Birthday) and SEX.
For infants under one year state the age in months as “under one month,” “one month,” etc.
3. Ages of Males
4. Ages of Females
PARTICULARS as to MARRIAGE
5. Write “Single,” “Married,” “Widower,” or “Widow,” opposite the names of all persons aged 15 years and upwards.
State, for each Married Woman entered on this Schedule, the number of:-
6. Completed years the present Marriage has lasted. If less than one year, write “under one.”
Children born alive to present Marriage. (If no Children born alive write “None” in Column 7.)
7. Total Children Born Alive.
8. Children still Living.
9. Children who have Died.
PROFESSION or OCCUPATION
10. Personal Occupation
The reply shoud show the precise branch of Profession, Trade, Manufacture, &c.
If engaged in any Trade or Manufacture, the particular kind of work done, and the Article made or Material worked dealt in should be clearly indicated.
(See Instructions 1 to 8 and Examples on back of Schedule.)
11. Industry or Service with which worker is connected.
This question should generally be answered by stating the business carried on by the employer. If this clearly shown in Col. 10 the question need not be answered here.
No entry needed for Domestic Servants in private employment.
If employed by a public body (Government, Municipal, etc.) state what body.
(See Instruction 9 and Examples on back of Schedule.)
12. Whether Employer, Worker, or Working on Own Account.
Write opposite the name of each person engaged in any Trade or Industry, (1) “Employer” (that is employing persons other than domestic servants), or (2) “Worker” (that is working for an employer), or (3) “Own Account” (that is neither employing others nor working for a trader employer).
13. Whether Working at Home.
Write the words “At Home” opposite the name of each person carrying on Trade or Industry at home.
14. BIRTHPLACE of every Person.
(1) If born in the United Kingdom write the name of the County, and Town, or Parish.
(2) If born in any other part of the British Empire, write the name of the Dependency, Colony, etc., and of the Province or State.
(3) If born in a Foreign Country, write the name of the Country.
(4) If born at sea, write “At Sea.”
NOTE- In the case of persons born elsewhere than in England or Wales, state whether “Resident” or “Visitor” in this Country.
15. NATIONALITY of every Person born in a Foreign Country.
(1) “British subject by parentage.”
(2) “Naturalised British subject,” giving year of naturalisation.
(3) If a foreign nationality, state whether “French,” “German,” “Russian,” etc.
If any person included in this Schedule is:-
(1) “Totally Deaf” or “Deaf and Dumb,”
(2) “Totally Blind,”
(4) “Imbecile” or “Feeble-minded,”
state the infirmity opposite that person’s name, and the age at which he or she became afflicted
17. LANGUAGE SPOKEN.
(1) If able to speak English only, write “English.”
(2) If able to speak Welsh only, write “Welsh.”
(3) If able to speak English and welsh write “Both.”
No entry to be made in this column for children under three years of age.
|1||Frank JUKES||Head||29||–||Single||–||–||–||–||Gamekeeper||–||Worker||–||Shropshire Burrington||English|
(To be filled up by, or on behalf of, the Head of Family or other person in occupation, or in charge, of this dwelling.)
Write below the Number of rooms in this Dwelling (House, Tenement or Apartment). Count the kitchen as a room but do not count scullery, landing, lobby, closet, bathroom; nor warehouse, office, shop.
I declare that this Schedule is correctly filled up to the best of my knowledge and belief.
Signature Frank JUKES
Postal Address Bwlch y llyn, Trefeglwys
I certify that:-
(1.) All the ages on this Schedule are entered in the proper sex columns.
(2.) I have counted the males and females in Columns 3 and 4 seperately, and I have compared their sum with the total number of persons.
(3.) After making the necessary enquiries I have completed all entries on the Schedule which appeared to be defective, and have corrected such as appeared to be erroneous.
Initials of Enumerator
CENSUS OF ENGLAND AND WALES 1911
Prepared pursuant to the Census (Great Britain) Act, 1910
This space to be filled up by the Enumerator
Number of Registration District 616
Number of Registration Sub-District 1
Number of Enumeration District 16
Name of Head of Family or Seperate Occupier
Mr. Frank JUKES
This Schedule must be filled up and signed by, or on behalf of, the Head of the Family or other person in occupation, or in charge, of the dwelling (house, tenement or apartment).