STRICTLY CONFIDENTIAL
Census District No.............................................
CENSUS OF; Bq,
This is a
disclosed about any individual.
for any other purpose
Sub-district No...................................................
Household Schedule No.....................................
Multi Dwelling No.............................................
Attached Form B. No(s)...................................
CATBGORY
OF DWELLING
BUIIDING IN WHICH
DWELLING SITUATED
AND NUMBER OF ROOMS
TENANCY STATUS AND
RENT PAID (if any)
(a)
(b)
(dl
(g)
-----
Large Hotel..................................
TYPE OF DWELLING
House of One Storey....................
........................................................ House Multi Storey.......................
Small Hotel ..................................
Apartment Building....................
................................................... Other................................................
Institution.,................................
(cl
........................................................ Number of Occupled
Occupied by Owner..........................................................
Entire House..........................................,.....,.
Rented
Unfurnished........................................................
Self Oontained Apartment ........................
Rented hed ............................................................
Rooms in House ............................................
Free Accommodation................ .;......................La
.........
Other................................................................
(h) WeeklyRent
E
S.
d.
or Monthly Rent. E
s.
d.
(el
(
i
)
Length
of
Rental
Agreement
or
Lease
.
Total Rooms..................................................
..........................
Months
............................
Years
(f) Bedrooms................................................
.
I
1
For Married
STJRNAME AND NAME
A
-
J
Include every person s p e n a g Oensus Night
in this dwelling who is resident in Bermuda.
Enter name of Head of Household first.
USE BLOOK LETTER8
I
-I
1
To the
Males
-I
For Females aged
18 years and over
Bead of the
Household
3
2
o
1
lo
1 -
--I
I
I
-I
5
6.1
-I 7
-I
-I
I
y-.,
private Dwelling ........................ Dwellings in Building ................
--
I
1
g l
YOU ARE ADVISED TO READ ATTACHED"NNOTES ON COMPILATION" BEFORE GA
-
TO COMPLETE "HE FORM
IF
RMUDA, 1960
- RESIDENTS
FORM A
I
No information will be
will not be used
of statistical tables.
I
Date
Enumerator
I
Supervisor
Preliminary
Filling up
FACILITIES
SUPPLY AND STORAGE
(1)
(J)
Tank piped indoors..............
Tank piped outdoors...........
Taak Dipped..........................
Msins Supply........................
(m)
Well Water................
used by ....................
..................dwellings
or)
Sea Water..................
None..........................
Watercloset........................
Gas Refrigerator......................
Pit Latrine.........................
Electric Refrigerator................
Bucket Latrine..................
(q) Electric Stove.................
used by
(I)
Radio ....................................
Households..........................
(8)
Television............................
I
-4
(VI
Ohildren uhder 13 years............................................
I
Principal Occupation
If born in
Bermuda
give Parish
otherwise
give COuntrJ
or island
-I--I
(u)
Females 13 years and over........................................
Kerosene Stove..................
(0)
Birthplace
lb
Males 13 years and over..............................................
Gas Stove............................
d
I
PERSONS IN DWELLING
ON UNSUS NIGHT (Form A)
@)
(n)
'
storage
....................gallons
I
HOUSEHOLD
EQUIPMENT
TOILET
SUPPLY, ADDITIONAL
l-
-I
Final
Filling up
WATER
No. of persons on this
schedule (not including
overseas visitors).
Males Females Total
3- 1
Work
Status
M
Subsidiary Ocoupation
If gainfully occupied, describe
the personal ocmpation by
which living is at present
mainly earned. State usual
occupation if unemployed.
16
18
19
21
22
23
24
26
2 1 .