et
Polish People ' s Republic
Central
FORA
A
Statistical Orfice
Bureau o f C e n s u s e s
\
I
National Census, 7 December, 1978
F O R M F O R
COLLECTlNG
AND
Voivodship
Town
.....................
....................
ON
D W E L L I N G
Number of attached additional
forms A..
No. of census district..
Successive no. of building in
census district.
.................
......
mobile unit o r provisional premises
......................
.............
a separate form A should be com-
f36....................
............
...............
of dwelling.. ......
No. df;.eA;r
DATA
I N H A B I T A N T S
F o r each o c c u p i e d dwelling,
Locality..name
Street /square, circus,etc.
ITS
pleted.
/.
TD.
Type of occupi& housing unit :
Dwelling
...............
1
-2
Mobile unit.
/specify/
/
Provisional premises.
..............
/specify/
Please encircle symbol number of the relevant type of housing unit. In t h e case of symbols 2 o r 3 t h e type of occupied
unit should be moE precisely s p ecified [ e . g, barge, t r a i l e r , b a r n , etc. /
NAME AND-FLRST NAME OF LODGER /USER OF DWELLING/.
....................................................
/
DESCRIPTION OF' DWELLlNG
Questions /topics/ should bt/amswered a s follows: 1
number should be encircled
i. USEFUL FLOOR
,'.
- II relevant figures should be written in;
III -X r e l m a n t symbc
,
SPACE /TOTAL[
TV.PIPED WATER
facilitkes l i n k e e
the public water supply s y s t a
W r i t e i n number of square metres /integery
without fraction[
Useful dwelling space equals
the sum of
spaces within dwelling, i. e ,- spaces
of rooms,
kifhen w i t h window or-without it y rooms not
occupied o r seasonally used, antichamber,
bathroom y toilet y pantry chamber, glazed
veranda y etc.
to
3
fi
'
such facilities i n dwell[ing nar i n buildins
II, NUMBER OF ROOMS
a/
V , FLUSH TOlLET
living rooms
kitchens with window,
with floor spac5pf 4 sq .In o r more
c[
other rocms
/e.g. not occupied rooms, seasonally
used rooms,
rooms f o r storing
household Pacilitie_s, etc,/
b]
Questions a s i n the case-of piped water facilities / s e e -pic
IV above/
,
total number of rooLms/a+b+c/
x / d o n t include pantry chambers o f r u r a l
ty$$lilapidated rooms
SPACE FOR KITCHEN NOT BEING
Space without window, o r of space below
4 sgu. m.
III,
there is such a space
no such space
1
o
VI.
SINK OR WASHBASIN
Questions a s in the case
af piped water facilities ;see topic I V above/
.3
v 1 I . I 3 n1.1i K L'eh:
I s i;,
w EL LI N c:
................ .1
.............2
thcre is not tub nor shower.. ........O
with tub o r showcr.
without tub o r siiawcr..
VIII. IIOT WATER SUFPLIES
Water heated outside dwelling i n p o w e r
stations o r i n . boilers for flat blocks ,etc.
Water heated in &welling /electric o r gas
stove/ , o r i n central heating boiler for one-farnilyhouse....................................
T h e r e a r e not hot water supplies..
.......... .1
2
.. ............ .O
.%
I X . G A S IN D W E L L I N G
I
X . HEATING
supplied from public network 1
from'bottles..
2
Gas
There is not gas i n dwelling..
O
.............
.....
heating
1collective, i.e . thermal ener-gy
I
I
is supplied from power stations , o r
frodboiler
f o r flat block.. ........ . I
I
indihdual, i. e. thermal energy is
supplied from boiler in one-family
CENSUS OF POPULATION /'INHABITANTS/ LIVING PERMANENTLY
1 NAME
NO?'
o1
OR TEMPORARILY I N DWELLZNG
2 FIRSTNAME
----_----------------------------------------------------------------------------------------------------------
3 . Permanently living /whether o r riot a given person is present in dwe€ling a t the census
time / ,
or temporarily staying /please encircle the relevant category/
/
/
9
A. permanently living
and present
B.permanently living but
not p r e s e n t
C . temporarily living
--------_-----_-----------------------------------------------------------------------------------------------4. Please specify for person c&s ified to the category €3, o r category C ,
cause of absence o r of temporary stavying
"----"--œ--"-"-""--œ"---.œ-œ---------œ----œ-."~---~-~--------*---~~--œ-----œ-œ~œ.-"-*-"œ.-"œœ~-œ-~~--"----"---œ.
-3-
18. Name of working establishment
- i n the case o f multi-establishment
-
I
~
.,
enterprise, both the name of e n t e r p r i s e
and that of the establishment concerned /type cf activity/should be specified ;
i f the working establishment is privately owned , beside i t s name the name
and second name of its owner should be writen in.
-..
---_---------------------------------------------------------------------------------------------------
xxx/Higher education completed
Higher educatiDn not completed - a f t e r general education
Hi-ghcr education not completed - after vocatzonal education
Post-secondary completed
Secondary education completed
secondary education not completed
Basic vocational ccmpleted
Primary education completed
Primary education not complcted
Self - educat io n
RQadinf, only
Neither writing nor reading
xxxx/ Employe e
Commis sioner /cornmi ssion-me rchant
Home-worker
Member of productive cooperative
U s e r of farm
Worker,o n own account
Aiding in work of.. /write in the relevan2
successive niunber of person enumerated
Cle rgyma n
,'
.
- 4 INF~OKMAI’ION O N t3UILDING WllERE. TIIE ENUMERATEU D W E L L I N G IS
Each building should be dc>scrib,cdonly onct2 i . c . this p a r t o f the form A shbuld be completed when enumerating the
dwelling m a r h c d with successive number 1 / o n e / ; when e n m e r a t i n s subsequent dwellings in h i l d i n g , this part should be
crossed.
A s to the topics I , I I , I V and V, relevant symbol number should be encircled; a s . to the topic III relevant information
should be written in.
- residential
- mixed type : f o r
-
IV. Height o f buildins
.
/number of floors/
ground-floor building
O
one - floor building
1
two -floor building
2
three -floor building
3
-four- floor building
4
fivè to nine-floor building 5
ten- floor building
6
eleven- floor building
7
twelve and over-floor
building
8
II. Period /_vear/ of construction
1. Type of b ~ l d i n ~
- before 1918
- 1918 - 1944
- 1945 - 1970
- f o r buildings constructed
1
residential
and economic purposes
2
collective housing unit. i. e .
at least a half of it is occupied by boarding school
hotel hospital, etc.
3
non-residential
4
X
9
O
a f t e r 1970 two last digifs
of construction y e a r should
be written in
III. Form of ownership
Owned by individual person
Write in name and first name
o f owner..
Owned by institution
Write i n full name of institution
being owner..
................
...........................
..................
..............................
V. Outer walls ’ material
1
codustible .
/e. g . b r i c k s , concrete,
etc. j
Combustible
2
/wood, etc.
Not
Is the building a t the disposal
of local state administration
body a .
Yes. No. Please encircle
the relevant
/
.....................
I N F O ~ M A T I O NON HOUSEHOLDS IN DWELLING
Successive number
of dwelling i n household
II
I
mcmbe r s hi p
in housing
cooperative
1
economy
1
I
ture
allocation of dwcliing /administrative allocation, o r tenure
contract with s o a a l i z e d e c o n my unit /
.
i n socialized econoWork
outside
agi-iculturl
,
Household occupies dwelling by the right of:
/Encircle the relevant s d p b o l number/
1
Please encircle
the relevant s.ymbol number
4
L
4
tenure contract /with individual
owner,or with member of housing cooRerativc.
5
5
5
sub-tenurc or part o r whole of
allocated d w e l liii9
6
6
relationship with
dwcllinc owncr
7
7
I.
I
paren ts
o r ctiildrcn
Succes sive n q b e r
of housebld in dwel
ing I
IJ
III
1
Im
1
II I
Successive number of person
being head of household
single o r shi red ownership
ENUMERATED
11. MAIN SOURCE OF INCOMES OF HOUSEHOLDS
I. RIGHT OF FLOUSEHOL/D TO
O C C U P Y I N G DWELLING /OR
PART OF DWELLI?JG/
6
..
Source
other
than
work
-7
0
employment 3
3
3
3
I