You can also fill out the form at www.scitani.cz
CENSUS FORM-BUILDINGS - CENSUS FORM TRANSLATION
Please fill the information out in the original form in Czech!!!
█ █ █ █ █ Building
█ █ █ █ █ █ █ █ █ █ House
██
no.
sequence no.
█ █ █ █ █ █ █ █ █ █ █ █ █ █ █ █ █ █ █ █ █ █ █ █ District
██████
code
█ █ █ █ █ █ █ █ █ █ █ █ █ █ █ █ █ █ █ █ █ █ █ █ █ Post code █ █ █ █ █
█ █ █ █ █ █ █ █ █ █ █ █ █ █ █ █ █ █ █ █ █ █ █ █ Census
██████
district
Orientation
█ █ █ █ █ █ █ █ █ █ █ █ █ █ █ █ █ █ █ █ █ █ █ █ █ █ no.
████
IDENTIFICATION
District
Municipality
Part of
municipality
Street
IDOB
Census officer to complete
Census officer to complete
The Population and Housing Census in 2011 is conducted on the basis of Act No. 296/2009 Coll. The Czech Statistical Office asks for your cooperation in filling out information in the
census forms, or by checking the pre-completed data. Individual and personal data is protected according to the relevant laws. Data shall be used exclusively for statistical purposes.
PLEASE READ THE INSTRUCTIONS AND EXPLANATIONS ON THE SECOND PAGE CAREFULLY BEFORE FILLING OUT THE CENSUS FORM
Column A is for pre-completed data from administrative sources, if available. If information is not completed in advance or does not correspond to the present
situation, indicate or write the correct data in column B.
Use a black or blue ball-point pen for filling out the form. Always choose one answer only from the listed options.
Mark the selected answer
; cross out a mistake completely
and mark correctly
. Write text and numerical data according to the examples in the
designated fields. Cross out data written by mistake and write the correct data in an empty space by the relevant question.
5. Period of construction or reconstruction
Examples:
A Á Ä BCČDĎE É Ě FGH I Í J K L ĽMNŇ
OÓÖÔ P QR Ř S Š T Ť U Ú Ů Ü VWX Y Ý Z Ž
1. Number of dwellings in the house
State the total number of dwellings
(including unoccupied).
2. Type of the building
A
B
A
B
family house - stand-alone
family house - semi-detached
family house - terraced
multi-dwelling house
other state according to primary function of building (see explanations)
1919 and earlier
1920 - 1945
1946 - 1960
1961 - 1970
1971 - 1980
1981 - 1990
1991 - 2000
A
B
2001 and later, state the year
6. Material of bearing walls
stone, brick, breeze-block incl. combinations
wall panels
adobe
wood
other materials and combinations
A
B
A
B
A
B
A
B
A
B
7. Number of floors (above the ground)
3. Occupancy status
occupied
unoccupied because of:
change of user
designated for recreation
reconstruction of building
unoccupied since issue of attestation
inheritance or court proceedings
unfit for habitation
another reason
A
B
8. Connection to sewerage
connection to sewage system
own waste water purifier
sump, septic tank
without a sewage system and cistern
9. Central heating and type of fuel
4. Type of owner
natural person
municipality
state
housing co-operative
another legal entity
co-ownership of dwelling owners (of units)
combination of owners
State the total number of floors above the ground
(including the ground floor).
A
B
THANK YOU FOR FILLING OUT THE CENSUS FORM-BUILDINGS
Date, first name and surname of person who filled out form
solid fuel boiler in the building
gas boiler in the building
other fuel boiler in the building
boiler outside the building
without central heating
10. Lift
yes
no