1971 C E N S U
......
I
70the Hiad (òr Acting Head) of the Household.
...
r
. *
'"w-
..... - *..- .
.
Please complete this form and have it ready for collection on Monday 26th April.
If you need help, do not hesitate to ask the enumerator.
The enumerator may ask you any questions necessary to help him to complete
or correct the form.
4 q h e information you give on the form will be treated as CONFIDENTIAL and used
only for compiling statistics. No information about named individuals will be
passed by the Census Office to any other Government Department or any other
authority or person. If anyone in the census organisation improperly discloses
information you provide, he will be liable to prosecution. Similarly you must not
disclose information which anyone (for example, a visitor or boarder) gives you to
enable you to complete the form.
The legal obligation to fill in the whole form rests on YOU, but each person who
has to be included is required to give you the information you need. However,
anyone who wishes can ask the enumerator or local Census Officer for a personal
form which can be returned direct to the enumerator or local Census Officer and
then you need answer only questions B I and B5 for that person.
1op-
,d '"I
,.
*'
i
-
. _ ".--
r 9 ' a r . r 1;
PLEASE TAKE NOTE
There are penalties of up to f50 for failing to comply with the requirements
described above, or for giving false information.
When you have completed the form, please sign the declaration at the foot of the
last page.
MICHAEL REED
Director and
Office of Population Censuses and Surveys,
Titc hf ield,
Registrar General
Fareham, Hants.
' E l
A
I
Answer questions Al-A5 about your
household's accommodation and then ans
questions BI-B24 overleaf and if appropri
answer questions CI-C7.
Al
H o w do you and your household occupy your
accommodation 7
3
os
cb
t
8
R
o
2
Ij
1
0
A s an owner occupier (including purchase
by mortgage)
2
By renting it from a Council or
N e w Town
3
0
0
4
0As a furnished letting
5
0
As an unfurnished letting from a private
landlord or company or Housing
Association
In some otherway
(Please give details, including whether
furnished or unfurnished)
..................................................
Note: If the accommodation is occupied by lease
originally granted for, or since extended to, more
than 2 1 years, tick 'owner occupier'.
A3
H o w many rooms are there in your
household's accommodation 1
..................
Do not count
Small kitchens less than 6ft. wide.
bathrooms and toilets,
sculleries not used for cooking,
closets, pantries and storerooms.
landings, halls, lobbies or recesses.
offices or shops used solely for
business purposes.
Note
A large room divided by a sliding or fixed partition
should be counted as two rooms.
A room divided by curtains or portable screens should
be counted as one room.
A4
H o w many cars and vans are
normally available for use by you
or members of your household
(other than visitors) 1
.................
IL
A2
Does your household share with anyone else the
use of any room, or hall, passage, landing, or
staircase 7
n YES
U
n NO
Include any provided by employers if normally
available for use by you or members of your household. but exclude vans used solely for the carriage
of goods.
If None, write 'NONE'.
u
1
US-ENGLANor Private Households
ehold comprises either one person living alone or a group of persons
may or may not be related) living at the same address with common
ousekeeping. Persons stayin9 temporarily with the household are
included.
I I 1
, ,,,
To be completed by enumerator
C.D. No.
E.D. No.
F o r m No.
Ref.
If sharing with another household :-
Hall, staircase, passage, etc., shared on/y/not only* f o r entry to accommodation.
*delete whichever is inapplicable.
......................
Number of rooms shared.
~
Name a n d full postal address :
....................................................................
...................................................................
...................................................................
................................................................
Where boxes are provided answer by putting a tick in
answer
,priate
the box against the answer which applies. For example,
if the answer is 'YES':
I J 1 YES
0NO
PLEASE WRITE IN INK OR BALLPOINT PEN
A5
Has your household the use of t h e following amenities on these premises?
a A cooker or cooking stove
with a n oven
b A kitchen sink permanently
connected to a water supply a n d
a waste pipe
u
1
2
3
1
2
3
0
- for use only by this household
Y E S - for use also by another household
YES
0N O
0Y E S - for use only by this household
0Y E S - for use also by another household
0 NO
..
0 Y E S - for use only by this h o u s e h o k
0YES - for use also by another household
1
c A fixed bath or shower
permanently connected to a
water supply and a waste pipe
1
2
3
d A hot water supply (to a
washbasin, or kitchen sink, or bath,
or shower) from a heating appliance
or boiler which is connected to a
piped water supply
e A flush toilet (W.C.) with
entrance inside t h e building
u
1
NO
~~
YES
YES
NO
- for use only by this household
- for use also by another household
0
0
10 Y E S - for use only by this household
2 0 Y E S - for use also by another household
2
3
3
f A flush toilet (W.C.) with
entrance outside the building
0
0
NO
0Y E S - for use only by this household
0 Y E S - for use also by another household
0 NO
1
2
3
~~~
~
PLEASE TURN OVER TO PART
B
b-
Complete a line in Part B for every person present, that is every person who
PART
a spends Census night 25/26 April 1971 in this household
B
-or b joins this household on Monday 26 April and has not been included as present or
I
For an y other person who usuillly lives i n this household complete a line in Part C on the back page.
B1
Fill in this column first for
every person present.
(see n o t e above)
82
Write t h e date of
birth of the
person.
Begin with t h e head of t h e
household (if present).
For a baby who has not yet
been given a name write
'BABY' an@*the surname.
-
84
If t h e person usually lives here,
w r i t e 'HERE'.
If not, w r i t e t h e person's usual
address.
male,
F for
f e m ale).
For boarders write 'HERE' only
if they consider this their usual
address.
For students and children who
are away from home during
term time give their home
address.
For persons with no settled
address write 'NON E'.
B L O C K CAPITALS PLEASE
(M for
Write name and surname.
1st person
83
Write
t h e sex
of the
person,
B5
Write 'HEAD' for t h e head of
t h e household and relationship to the head for each of
t h e other persons: for example 'Wife', 'Son',
'Daughter-in-law', 'Visitor',
'Boarder', 'Paying Guest'.
B6
Write 'SINGLE',
'MARRIED',
'WIDOWED' or
'DIVORCED' as
appropriate.
If separated and
not divorced
write ' M A R R I ED'.
87
Did t t
April
Tick 1:
o r if 1
sick, 1
If t h e
or 5
exam
This (
of ag
1c
Month Year
2 c
3c
4
c
5 c
-
-
~
2nd person
1c
Month Year
2 c
3 c
3 r d person
4
c
5
c
1c
Month Year
2 c
3 c
4 c
5
4th person
c
1 c
2 c
Month Year
3 c
4
c
5
c
5th person
1c
2 c
Month Year
3 c
c
5
c
-
6th person
4
1 c
Month Year
2 c
3 c
c
4
5 c
-
If there are more than six persons present continue on a new form.
(The enumerator will supply you with one if he has not already done so.)
7
2
O
sent on a Census form elsewhere.
88
Will the person be a
student attending
full-time a t an
Tick box 1 if the person had a job even if it was only part-time educational
or if the person was temporarily away from work, on holiday, establishment during
the term starting
sick, on strike, or laid off.
April/May 1971 ?
If the person did not have a job tick whichever of boxes 2, 3, 4 (see note 88)
or 5 is appropriate; if box 5 is ticked state the reason; for
This question need
example 'Housewife', 'Student', 'Permanently sick'.
not be answered for
This q u e v need not be answered for children under 15 years children under 15
years of age.
ofage.
,
87
Did the person have a job last week (the week ended 24th
April 1971)1 (see note 87)
1
2
3
4
5
0YES - in a job at some time during the week
0NO - seeking work or waiting to take up job
0NO - intending to seek work but sick
0 NO - wholly retired
seeking work for some other reason,
0NO - notnamely
2
3
4
5
0YES - in a job at some time during the week
0NO - seeking work or waiting to take up job
0NO - intending to seek work but sick
0NO - wholly retired
seeking work for some other reason,
0 NO - notnamely
0YES
2
3
4
5
0YES - in a job at some time during the week
0 NO - seeking work or waiting to take up job
0 NO - intending to seek work but sick
0NO - wholly retired
seeking work for some other reason,
0NO - notnamely
o
No
2
3
4
5
0YES - in a job at some time during the week
0NO - seeking work or waiting to take up job
0NO - intending to seek work but sick
0NO - wholly retired
seeking work for some other reason,
0NO - notnamely
..........................................
1
2
3
4
5
o
0
YES
NO
0
0NO
0NO
NO
0 YES
namely
..........................................
1
2
3
4
5
0YES - in a job a t some time during the week
0NO - seeking work or waiting to take up job
0NO - intending to seek work but sick
0NO - wholly retired
seeking work for some other reason,
0NO - notnamely
..........................................
Born in
0
England
02 0Wales (incl.
Monmouthshire)
o
O1
03
0Scotland
0Northern
Ireland
................................
and entered U.K. in .......................
Born in
Born in
England
0
02 0Wales (incl.
Monmouthshire)
or b
No
Born in
O1
03
................................
a
0 YES
o
Born in
0
England
u
02
Wales (incl.
Monmouthshire)
No
Born in
a
0YES
0YES
O1
0
03
Wales (incl.
M on mouthshire)
0Scotland
0 Northern
Ireland
................................
and entered U.K. in ........................
Born in
0
02 0Wales (incl.
Monmouthshire)
b
Mother born in (country)
W
-œ
a
Iz
o
Father born in (country)
o1
03
I
bi
W
3
U
b
W
Mother born in (country)
I
I-
O.
a
5u
Father born in (country)
b Mother born in (country)
W
m
a
Father born in (country)
b
Mother born in (country)
a
Father born in (country)
b
Mother born in (country)
a
Father born in (country)
b
Mother born in (country)
O
I-
(country)
(year)
0Scotland
0Northern
Ireland
........................
....... (country)
and entered U.K. in ............. .......... (Year)
Born in
a
0YES
Father born in (country)
(country)
or b
No
a
(Year)
or b
No
This question should be answered
even if the person's father or
mother is no longer alive. (if
country not known, write 'NOT
KNOWN'.)
Give the name by which the
country is known today.
.........:, ............. (year)
Born in
0
England
02
b the person's mother
(country)
0Scotland
0Northern
Ireland
................................
a Born in
England
o
03
a the person's father
(year)
or b
and entered U.K. in
u
O1
B1O
Write the country of birth of:
(country)
0 Scotland
0Northern
Ireland
and entered U.K. in ........................
- in a job at some time during the week
- seeking work or waiting to take up job
- intending to seek work but sick
- wholly retired
- not seeking work for some other reason,
b
a
..........................................
1
If the person was born in England or Wales
or Scotland or Northern Ireland tick the
appropriate box.
or
If the person was born in another country,
write the name of the country (using the
name by which it is known today) and the
year in which the person first entered the
United Kingdom (that is England, Wales,
Scotland and Northern Ireland).
or b
...........................................
1
a
a
..........................................
1
B9
02
Born in
England
0
u
or b
Born in
Wales (incl.
M on mouthshire)
O1
0Scotland
03
0
................................
and entered U.K. in ........................
Northern
Ireland
I
(country)
(Year)
3
PLEASE TURN OVER TO THE NEXT PAGE-+;
,
1971 CENSUS FORM
NOTES
These notes are t o help you answer some of the questions in Part B
(for persons present). In cases where they also apply to Part C (absent
persons) this is shown in Part C .
If you have any further difficulty with these, or any other questions,
please ask the enumerator about them when he calls to collect your
form.
87
Job last week
A job means any work for payment or profit.
In particular it includes:
(a) work on a person's own account
(b) part-time work, even if only for a few hours, such as jobbing
gardening or paid domestic work
(c) casual or temporary work of any kind (for example seasonal work,
week-end work and vacation work by students)
(d) unpaid work in a family business, for example a shop or farm.
Unpaid work, other than in a family business, does not count as a job.
B8
Students
Do not count as full-time students people who are :
(a) on day release from work to attend school or college
(b) attending night school only
(c) attending an educational establishment provided by employers,
such as an apprenticeship school.
B15 Employer's name and business
Describe the business fully and try to avoid abbreviations or initials.
General terms such as 'manufacturer', 'merchant', 'agent', 'broker',
'factor', 'dealer', 'engineering', are not enough by themselves and
further details should be given about the articles manufactured or
dealt in.
For civil servants, local government officers and other public officials
give the name of the Government department, local authority or
public body and the branch in which they are employed.
For people employed solely in private domestic service write 'PRIVATE'
in answer to this question.
For members of Armed Forces see special note overleaf,
BI 6 Occupation
Full and precise details of occupation are required.
If a person's job is known in the trade or industry by a special name
use that name.
Terms such as 'scientist', 'technician', 'engineer', 'machinist', 'fitter',
'foreman', 'checker' should not be used by themselves, Greater
detail is required as for example :Tik
woodworking machinist, civil engineer, toolroom foreman.
For civil servants, local government officers and other public officials
give their rank or grade.
B17 Self-employed
'Self-employed, employing others' means having one or more employees other than 'family workers'. A 'family worker' is one who
lives in the same household as the employer and is related to him.
Although 'family workers' are not counted for the purpose of deciding
whether an employer has employees, they should themselves be
recorded as employees.
Answers should be written on the line on which
the person's name appears in column BI
B18 Apprentioes, etc.
Answer this question only for a person who is undergoing training for
a period fixed in advance and leading to recognition as a skilled
worker or technician or to a recognised technical, commercial or
professional qualification or managerial post.
Do not answer this question for a young person undergoing probationary training who has not yet entered into formal apprenticeship.
B20 Place of work
For people who do not work regularly at one place or who travel during
the course of their work (for example, sales representatives, seamen
and some building and transport workers) :
%(a)
if they report daily to a depot or other fixed address give that
address ;
(b) if they do not report daily to a fixed address write 'NO FIXED
PLAC E'.
B11
W a s the person's usual address
one year ago (on 25th April
1970) the same as that shown by
the answer to question 647
B12
Was the person's usual address
five years ago (on 26th April
1966) the same as that shown by
the answer to question Bl1 7
Write 'YES' or 'NO'.
If no, write also the usual address
on 25th April 1970.
Write 'YES' or 'NO'.
If no, write also the usual address
on 25th April 1966.
For a child now under one year of
age, write 'UNDER ONE.
For a child now under five years of
age, write 'UNDER FIVE'.
BLOCK CAPITALS PLEASE
BLOCK CAPITALS PLEASE
For people such as building workers employed on a site for a long
period give the address of the site.
For dock workers give the name and address of the dock or wharf at
which they are usually employed.
B21 Means of transport
If the person uses different means of transport on different days give
the means used most often.
Do not use terms such as 'public transport' or 'private transport' but
give the actual means used, for example, 'train', 'bus', 'car', 'bicycle'.
W
5
z
z
o
!-
3
3
c1
W
I
c
u
z
t;
n.
A
2
O
o
W
z
a
W
m
W
D
I
u
2
n
W
m
O'
c
C
8
h
s
w
SPECIAL NOTE FOR MEMBERS OF ARMED FORCES
At B I 5 (or, if appropriate, C5) give arm and branch of service.
At B I 6 (or C6) give rank or rating only.
Questions B I 7 (or C 7 ) , B I 8, B I 9 and B22 need not be answered.
4
B14
Has the person obtained a n y of t h e f o l l o w i n g qualifications since reaching the age o f 18 ?
B13
Has t h e person obtained any o f the
following ?
a H.N.C. or H.N.D.
b Nursing qualifications
c Teaching qua Iif icati ons
G . C. E. 'A' level
Higher School Certificate (HSC)
Higher grade o f Scottish Certificate o f
Education (SCE)
Higher grade o f Scottish Leaving
Certificate (SLC)
Ordinary National Certificate (ONC)
Ordinary National Diploma ( O N D )
If so, give full details of all such qualifications in the order in w h i c h they were obtained, even if n o t relevant to t h e present job or if the person is n o t working.
If none, w r i t e 'NONE'.
Please check these details by asking each person about his qualifications.
This question need not be answered for gersons under 18 or retired persons over 70,
This question need not be answered fi
children under 15 or retired persons
over 70.
1
2
3
4
u
d Degrees. diplomas or other educational qualifications
e Graduate or corporate membership of professional institutions
f Any other professional or vocational qualifications
Qualification
Major Subject or Subjects
G C E ' A level or H S C
0 SCE higher or SLC higher
0O N C ~ ~ O N D
u
A w a r d i n g Institution
..
i
I
I
I
I
N o n e of these
*
1
L
0 GCE *A#
level o r HSC
0SCE higher or SLC higher
0O N C ~ ~ O N D
0 N o n e of these
.
.
.
..
...
4
0GCE'A level or HSC
0 SCE higher o r SLC higher
0O N C o r O N D
0N o n e of these
1
u
2
0SCE higher or SLC higher
.
.
1
2
3
4
1
2
3
u
4
0N o n e of these
1
u
3
4
I
..
ii
.
I
*I
*
8
*
G C E X tevel or HSC
3
2
I
I
I
'
ONCorOND
.
*
..f
..
.
GCE 'A'
tevet o r HSC
I
i
0 SCE higher o r S L C higher
0O N C ~ ~ O N D
0 N o n e of these
*
.
.
..
*
I
I
I
-.
1
2
3
4
0GCE'A
u
tevel or HSC
SCE higher or SLC higher
I
.
0O N C ~ ~ O N D
0 N o n e of these
I
.
5
PLEASE TURN OVER TO THE NeXT PAGE
-I)
The remaining questions in Part B do not apply to children under 75 years of age.
~
~~
Answer questions B I 5-BI7 in respect of the main employment last week,
or of the most recent job if retired or out of work.
For persons who have never had a job and for a housewife who did not have a job last week write 'NONE' at B15.
B i5
What was the name and business
of the person's employer (if selfemployed, the name and nature of the
person's business) ?
(see note 815)
B16
a What was the person's occupation?
B17
Was the person
Give full details. (see note B16)
an employee,
or
self-employed
employing others
(see note B17).
or
self -employed
without employees ?
b Describe the actual work done in
that occupation.
Give the trading name if one was used.
*
a Occupation
8 Nameof
business
sP
8
F
b
1
Nature of
business
b
u
3
0Self-employed
without employees
a Occupation
business
1
s
E9
2
2
Description of work
h
a Nameof
2
b
ru
b
Nature of
business
0An employee
Description of work
3
Self-employed
employing others
(see note B17)
0An employee
0Self-employed
employing others
u
(see note B17)
Self-employed
without employees
~~
a Nameof
a Occupation
business
1
2
%
b Nature of
b
business
b
&
0An employee
0Self-employed
employing others
(see note B17)
Description of work
-
elf employed
without employees
a Nameof
a Occupation
business
1
C
0An employee
2
$
kP b Nature of
b
business
S
P
Self-employed
employing others
(see note B17)
Description of work
elf - employed
without employees
~~
l
a Nameof
a Occupation
business
1
C
P
S
b
b
Nature of
business
An employee
elf-employed
employing others
(see note B17)
2
àj
0
Description of work
elf -employed
without employees
~
a Nameof
business
a Occupation
1
s
$
b
Nature of
business
b
0An employee
elf-employed
employing others
(see note 817)
Description of work
3
0Self-employed
without employees
B18
If the person is an apprentice
or trainee, write
'Apprentice',
'Articled clerk',
'Articled pupil',
'Student apprentice',
'G raduate apprentice',
'Management trainee',
'Trainee technician', or
'Trainee craftsman'
as appropriate. (see note 818)
'
2
!
f
Bi!
Ho\
Per
the
wol
EXC
ana
2-
For all persons with a job last week.
Forpersons with more than one job these questions apply
B19
How many hours
per week does
the person usually
work in this job?
Exclude overtime
and meal breaks.
B20
What is the full address of the
person's place of work?
(see note B20)
If the work is carried on mainly
at home write 'AT HOM E'.
BLOCK CAPITALS PLEASE
to the main employment last week.
B21
What means of transport
does the person normally
use for the longest part, by
distance, of the daily journe\
to work? (see note 821)
If the person walks to
work, or works mainly at
home, write 'NON E'.
B22
Was the person's
occupation one year
ago the same as last
week ?
If so, write 'SAME'.
If not, give details of
the occupation one year
ago. (see note 616)
If none, write 'NONE'.
7
For women aged under 60 who are married,
widowed or divorced.
624
B 23
Enter the month and year of birth
of each child born alive to her in
marriage ; include any who have
since died.
a Write the month and year
If none, write 'NONE'.
b If the first marriage has
ended (by the husband's
death or by divorce) write
the month and year when it
ended. If not ended, write
'NOT ENDED'.
Enter the dates in order of birth,
starting with the first born.
If she has been married more than
once give the dates for the
children of all her marriages.
Month
Year
of marriage (the first
marriage if married more
than once).
a Date of (first) marriage
Month
Year
FOR
DFFlClAL
USE
H CA
ÛCE
................
................
b Date (first) marriage ended
Month
Year
MIG 5
MIG 1
...............
...............
~~
Month
Year
a Date of (first) marriage
Month
Year
HCA
................
GCE
................
QM
b Date (first) marriage ended
Month
Year
MIG
Month
Year
a Date of (first) marriage
Month
Year
...............
1 ...............
MIG 5
H CA
GCE
................
................
QM
b Date (first) marriage ended
Month
Year
MIG 5
MIG 1
Month
Year
a Date of (first) marriage
Month
Year
H CA
GCE
..............
...............
................
................
QM
b Date (first) marriage endec
Month
Month
Year
Year
a Date of (first) marriage
Month
Year
MIG 5
...............
MIG 1
...............
HCA
................
GCE
..'b............
OM
b Date (first) marriage endec
Month
Month
Year
Year
a Date of (first) marriage
Month
Year
b Date (first) marriage endec
Month
MIG
...............
1...............
HCA
................
GCE
................
MIG 5
OM
Year
...............
1 ...............
MIG 5
MIG
PLEASE TURN OVER TO PART b
-C
PART Complete a line i,n this part for any person who usually lives in thi!
whom, therefore, you have made no entry in Part B.
C
I
If no one is absent tick this box+
c1
a Write the name and
surname of every person
usually living in this
household who is absent
on Census night.
b Write relationship to
the head of the household,
for example 'Head',
'Wife', 'Son',
'Daughter-in-law'.
1
st absent person
a Name
c2
Write the
.t .
0
sex,
Questions C4-C7 need not be answered for absent
c3
Write 'SI NGLE',
(M for male, F for
'MAR R 1ED',
female),
'WIDOWED' or
and date of birth of
'DIVORCED' as
the person.
appropriate.
If separated and
not divorced
write 'MAR RI ED'.
Sex
c4
Did the person have a job'last week (the
week ended 24th April 1971) 7
(see note B7)
Tick box 1if the person had a job even if it
was only part-time or if the person was
temporarily away from work, on holiday, sick.
on strike, or laid off.
If the person did not have a job tick whichever
of boxes 2, 3, 4 or 5 is appropriate ; if box 5 is
ticked state the reason ; for example 'Housewife', 'Student', 'Permanently sick'.
0YES - inthe
a job at some time during
week
2 0NO - seeking work or waiting to take
up job
3 0NO - intending to seek work but sick
4 0NO - wholly retired
5 0NO - not seeking work for some other
reason, namely
1
......................................
2nd absent person
a Name
Sex
0YES - inthe
a job at some time during
week
2 0NO - seeking work or waiting to take
up job
3 0NO - intending to seek work but sick
4 0NO - wholly retired
5 0NO - not seeking work for some other
reason, namely
1
......................................
3rd absent person
a Name
Sex
.._.._______.......-----------------------------b
Relationship
0YES - inthe
a job at some time during
week
2 0NO - seeking work or waiting to take
up job
3 0NO - intending to seek work but sick
1
4
a
6
0NO - notreason,
seeking work for some other
namely
NO
- wholly retired
......................................
4th absent person
a Name
Sex
............-..______---------------------------b
Relationship
0YES - in the
a job at some time during
week
2 0NO - seeking work or waiting to take
up job
3 0NO - intending to seek work but sick
4 0NO - wholly retired
5 0NO - not seeking work for some other
reason, namely
1
......................................
Important
If there is anybody that you have not listed in Part B or Part C
because you were not sure whether he should be included or because
you had no room on the form please ask the enumerator t o help you.
8
this household but who is not present and for
sbsent persons under 15 years of age.
ie
it
as
k.
er
is
e-
~
Answer questions C5-C7 in respect of the main employment last week, or of the most recent job if retired
Dr out of work. For persons who have never had a job and for a houseNife who did not have a job last week, write ' N O N E ' at C5.
c5
flhat was the name and
business of the person's
employer ( if selfemployed, the name and
nature of the person's
business) ?
(see note 815)
C6
What w a s the person's
occupation 7
e7
Nas the person
an employee,
or self-employed
employing others
(see note 817).
or self-employed
without employees
Give full details.
(see note B16)
Give the trading name if
one was used.
a Nameof
business
1
0An employee
ke
elf -employed,
ck
others
(see note B17:
b Nature of
her
business
...
employees
a Nameof
business
\
1
0An employee
Ike
elf - employed,
ck
0'employing
others
(see note B17:
b Nature of
ther
business
....
a Nameof
business
1
0An employee
1
0An employee
ike
ck
b Nature of
ther
business
....
a Nameof
business
ike
0Self-employed.
employiT.
others
ick
b Nature of
lthe
business
(see note B17
....
-
Declaration to be made by the head of the household or other person
making the return.
I declare that this form is correctly completed to the best of my knowledge and
L
belief.
Signature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Date
..........................................
I