| No of Schedule |
ROAD, STREET, &c., and No. or NAME of HOUSE |
HOUSES |
NAME and Surname of each Person |
RELATION to Head of Family |
CON- DITION as to Marriage |
AGE last Birthday of |
PROFESSION or OCCUPATION |
Employer, Employee, Neither |
Employer |
Employed |
Neither Employer or Employed |
Where Born |
If (1) Deaf and Dumb (2) Blind (3) Lunatic (4) Imbecile, feeble
minded |