SAMPLE CENSUS QUESTIONNAIRE
TORY CI
CONFIO~NTIAL
COMMONWEALTH CARIBBEAN POPULATION CENSUS-BERMUDA
OCTOBER 17, 1970
ACT 1950 NO 19
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10-
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0
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20
30
40
50
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s 5)
70
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~
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90
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SAMPLE CENSUS QUESTIONNAIRE
SAMPLE CENSUS QUESTIONNAIRE
INSTRUCTIONS
1. Please use the 62 black-lead pencil supplied when marking your answers to the questions on this
If you make a mistake, erase
form. DO NOT USE INK, BALLPOINT PEN, OR COLORED PENCIL.
cleanly and then fill in the answer space you want. Be sure to fill a response position (:::::) for each
question where the question applies to the individual. Each answer space you mark should be
filled in completely w i t h a black mark, the same as shown i n the SAMPLE QUESTION.
SAMPLE QUESTION
EXAMPLE
OF HOW
ANSWER
THE QUESTIONS
LESS T H A N
-
;o;;N;;AFO
A
MONTH A G O
MAKE NO EXTRANEOUS MARKS OF ANY KIND ON THE FORM
2. Do not mark or write i n the shaded areas. The areas will be marked'in the central office.
3. When you have finished questions 1 through 22, carefully fold at perforation and continue w i t h
questions 23 through 46.
4. Try to make your marks as shown here:
Do not make them
too light
-
too short
-.
too long
or too thin
-
m,d.,,mo~
A r.adobl.
mmrh
i,.~,,h~..~~~~~~~~.~.d
M.~~~.o.~oo
M . . ~ ~ ~ . I o ~ ~
~..~h~.e....d
i
SAMPLE CENSUS QUESTIONNAIRE
(Hotels and Guest Houses)
POPULATION CENSUS.BERMUDA
OCTOBER 25, 1970
-- L X l - - - - -
NOTE: EXAMPLE
John Smith aged 21.
1. NAME O F
INDIVIDUAL
2.
..
..
. . . . ... .... .
~
. .. . . ................, ......
HOTEL OR
GUEST HOUSE
4. SEX
5. AGE I N
COMPLETED
YEARS
3. ROOM NO. .....
Male
Female
-
- -0
10
20
30
40
60
70
8b
90
=
0
=
=
=
=
=
=
==
2
3
4
5
6
1
50
- - - - - - - - 8 a_
1
Never Married
Married
6.
MARITAL
STATUS
7.
PLACE O F
USUAL
RESIDENCE
8.
~
-80
90
8
9
- - -
Widowed
-
-
Divorced
Legal
Not
Sep. Stated
- - - -
U.K. Az/Port USA Canada France Germ Other Not
Count S E d
- - - - - --------10
20
30
40
50
60
70
80
90
LENGTH O F
---------STAY
(NIGHTS)
0 2 l 3 A 5 6 18 $_
CENSUS OFFICE
DEPARTMENT O F FINANCE
HAMILTON, BERMUDA
(Act 1950 NO. 19 5.5)
FORM C.2
Confidentla1