Name ..........................................................................................................
Christian name ...................................................................................................
Community .............................................................................................
Kreis ........................................................................................................................
StreeVHouse No. ..........................................................................................
Enumerationdistrict
Private telephone in dwelling (No.) ....................................................................................
@ Sex
0 Date of birth
nation
<
@Are
U
-
<
<
>-
<
>-
@Where
German
Non-German
If not German, which?
0 Do you have another dwelling or accommodation?
If yes:
No
Yes
Yes
NO
Yes
NO
Yes, as main domicile
Street
<
>
<
>
>
---
<
>
<
>
<
>-
<
<
>-
(
>-
<
<
Which means of
@transport do you
mainly use
(longest distance)
on your way out
to work or school/
university ?
<
>
<
>
>
<
<
-@
- normally
How much time
do you
need
for your way out
to work or school/
university ?
) -
<
--
@
@Are
{
Driver
Passenger
Does not apply as on same premises
Under 15 minutes
15 to under 30 minutes
30 to under 60 minutes
60 minutes and more
-
<
<
>-
<
>-
<
>
<
>-
<
)
..................................................................................................................
Wage earner/homeworker
Industrial apprentice
Salaried employee
you
Commercial, technical,
administrative apprentice
OfficiaVjudge
Self-employed
Unpaid family worker
@ How long do you
Under 15 hours
15to24hours
25 to 36 hours
Over 36 hours
normally
work per week?
Do you pursue
@any further
activities?
Agricultural activity
Other activity
DO NOT COMPLETE THIS PART
T
2 D.o.b.
12 Ld.
Corn.
5.
R.
6 C.
Full-time or advanced full-time
vocational- school *)
Engineering school
University (also teacher training)
Population Census 1970 (10%)
) -
Factory bus, school bus
Public or private regular bus
Final high school examination
u
# -
<
Metropolitan, underground, elevated railway
U
Full-time or advanced full-time
vocational school *)
Engineering school
University
*) Also school for technicians Primary school
@ Did you complete
a school?
Compulsory part-time vocational school
If so, which?
Completed 10th grade
<
No means of transport (walks)
Train
. Tramway
Branch of business of the establishment
establishment
Primary school
Intermediate school
High school
>
Branch of busineSS
(branch of economy, line) of the
..................................................................................................................
) -
Social assistance and other benefits
Compulsory part-time vocational school
<
I
For economically active persons (also self-employed,farmers,
O w n property, letting, interest, farm annuity
Are you at present
attending a school ?
If so, which?
>
family workers)
(firm, agency)
Economic activity
Unemployment benefits or relief
Own pension etc.
Support by parents, husband, etc.
>
<
Motorcycle, moped
) -
c) Are you officially
What is your
main source
of livelihood ?
)
<
House number
) -
<
Yes, as secondary domicile
Not registered
Yes
d) Is this other dwelling/accommodation abroad?
No
<
Bicycle, other means of transport (excl. car)
a) Do you go to work or schooVuniversity from the
other dwelling/accommodation?
b)Do you live most of the time in the other
dwelIing/acco mmodat ion ?
registered in the other
dwelling/accommodation ?
<
Community and Kreis of establishment, branch, building site or school
Car
.........................................................
) -
do you work or go to school, university?
Other religious
@ Citizenship
>
<
...........................................................................................................................................................................
Person not related to H H
communities
--
<
Name of establishment or school/university
Another person related to HH
by blood or marriage
If others, which?
Economically active
Farmer
Unpaid family worker
Unemployed/looking for work
Not economically active
Housewife
Regular soldier
For economically active persons (also self-employed, farmers,
family workers) as well as pupils and students
Father, mother of H H * )
Grandfather, grandmother of H H *)
Protestant Church (excl. Free Church)
Free Protestant Church
Roman-Catholic Church
Other Christian communities
Jewish religious community
Nocommunity
you
) -
Wife/husband of HH
Son (-in-law), daughter of H H *)
Grandchild, great-grandchild of HH *)
..........................................................
............................................................
>-
Head of household (HH)
sider
as HH.
c
) Every other person
having a separate house
hold or one ~jointly with
.'
Others
')Also of wifelhusband of HH
@ Religious denomi-
) -
<
Single
Married
Widowed
Divorced
@ Position in the
Head of household (HH) can
be:
a) Both spouses
b) One of the spouses
alone, unless both con-
<
Dav ................... Month ................... Year .........................
@ Marital status
household
Male
Female
Str. (distr.)
H.SNO.
-
<
)
<
>-
<
) -
-
<
) -
<
>-
<
) -
<
)-
<
)-
<
) -
15.B.o.b.
This page to be completed by persons with German citizenship only
For all Dersons
@ Residence
For self-employed
Federal Republic incl. Berlin (West)
on 1 Sept. 1939
(outbreak of war)
For persons born later than
1 Sept. 1939.
Residence of father on
1 Sept. 1939 or, if residence
of father is unknown,
residence of mother
Eastern neighbour countries,
‘South-Eastern Europe
Other regions
0 Did you arrive after
Yes
No
the end of the war
from the Sovietoccupied zone
or East Berlin?
I
>-
I
>-
c
>-
c
>-
<
>-
I
>-
<
>-
<
>-
@ HOW many persons
are employed in your
establishment?
(Incl. working proprietors,
managers, unpaid family workers)
@ Are some of them wage or salary earners?
I ’
1
tity Card or a Federal Refugee Identity Card?
Identity Card A
Identity Card B
Identity Card C
I
>-
<
>-
<
>-
i
active?
>-
<
>-
farmers, family workers)
Which of the following
@ schools
did YOU attend
and complete?
.........................................
/”
@ Main branch of
Automatic/sem¡-automatic machine
Anot)a& machine
No machine
Under 300DM
300 to under
500 DM
500 to under
800”DM
800 to under 1.260 DM
1,200 to under/800
DM
1,800 to under 2,500 DM
2,500 DM and more
income do you
derive from your
economic activity?
(Not to be answered bv
self-employed in agriculture
and by unpaid family
workers)
I
>-
<
>-
<
>-
<
>-
<
>-
<
>-
<
>-
<
>-
<
>-
<
>-
Supervisor, factorypaster,
master of a tpde, etc.
enterprise or establishment
Working in another managerial
or supervisory position
35 M. b.o. st. 36 Y.
24 T.
37 M.
39 Ch.
>-
.............................................................................................
School for technicians
I
Other full-time or advanced full-time
vocational school
<
)
<
)
I
>
--
(See explanations)
.............................................................................................
@ Year of completion
of last level?
19 .................................
For married, widowed and divorced persons
@
When was your present or last marriage contracted?
19 ..........................................
Have you ever been
Yes
NO
@ married before?
Birth years of all legit-
<
>-
<
>-
I
>-
<
>-
@ imate children born
alive
U
DO NOT COMPLETE THIS PART
28 Ernpl. p.
.............................................................................................
I
) -
>-
For women
(excl. self-employed)
23 Former e.a. 24 OCC.
(
stud-
ies of last level
completed?
For persons in managerial or supervisory positions
@ Are you
I
take at the schools
mentioned under @
until the last level was
Number of years .............................................
completed ? (See explanations)
(operation,material or
commodiiy etc. handled)
@ What monthly net
NO
Yes
How many years did
................................................................................................
@When
doing your
work are you
mainly operating
m*
@ the entire education
/
b) Description in
condensed form
ar
Engineering school
University (incl. teacher training)
(Not a compulsory part-time
vocational school0
@ ;rl$uoefdactivity
(for officials state title)
I
’
(also self-employed,
a) Occupation
I
I1
I
For persons who completed a vocational school or university (also teacher training)
J
For economically active persons
I
ha
was this training
intended?
<
I
I
I
Have you completed
any practical vocationIf yes : ...................................................
al training?
Length in years
@ In which year did
19 ....................................
1
(Incl.area taken on lease,
but excl. area let on lease)
@ For which occupation
Yes
No
) -
For Dersons over 14 vears
(also housewives, recipients of pensions)
Have you formerly
@ been
economically
<
Read explanations carefully!
(Apgrentice hip, on-the-job
trainino. etc4
For economically non-active persons over 14 years, ,f
I
I
For owners or tenants of agriculturally used areas.
Garden land not under 0.5 ha (5,000 m2)
/‘
If so, which?
Yes
NO
U
@
Do you have a Fed-
you give up your
economic activity?
Number .............................................
1 How large is the
total area?
@ eral Expellee Iden-
/f
q!$j)&
30 h
a
12 345 678
rn
No children
1st
2nd
3rd
4th
5th
6th
child
child
child
child
child
child
I
>
-
19............ 7th child 19............
19............ 8th child 19............
19............ 9th child 19............
19............10th child 19............
19............ 11th child 19............
19............12th child 19............
31 P. v. t. 32 T. OCC.
34 N. o. y.