I
~N~.L~f£RATION AREA
STRiC'ILY
I,
i
CON2rlDF_,NTIAL
POP U L AT1~96~9 CE N S US
i__~
BIRTHPLAC~
TRIBE
NA~-~
RELAT;ONSHIF
SEx
OR NATIONALITY
Write
M for
Males
and F
For Kenya Africans
state Tribe
For others, state race,
Country of Citizenship
AGe
State •
Age in
[
co~n-
pieted
Females I ),ears
for
(c)
MARITAL
I f born in District wher~
enumerated, write "'Here"
EDUCA TIO~
STATU~
State whether Single,
Married, Widowed,
Divorced or Separated
1./"born elsewhere
in Kenya, state District
State highest
Standard or Form
cam pleted
B
Father
alive ?
Is
Mother
alive ?
A ns wer
Answer
Ye~/or
~Tj r
O f th¢ ch~tdrea~ ~
~
ever bor~e a l ~ - Da~e of t~'te L ~ r
g~c'e bi~:h
I f born outside Kenya, state
Country
(/)
(e)
(h)
many
How
iiving
elsewhere?
ho.ve
dL-~ ?
(k)
(/)
03
t
How
How
many
are now
living
with
you ?
(~)
V ~
(o'.~
1
t
T"----
1
I
U
i
;
I
1
½
j
Li
Ti
t
-._~
5
i ,
-i
6
L_
L_~
---1
i
i
,
m
9
0
I
L' t
L r
L
i i
L__'
--L----.--i
c
Enumerator's Signature
................................
Supervzsc, r' s Signature
:t
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