|
|
|
||||||||||||||||
|
|
|
Province ____________________________________________ District No.________________________________ |
S. District No.________________________________ Enumeration District ________________________ In_______________________________{ City, town village, township or parish) |
||||||||||||||
|
VISITATION ORDER #
|
RESIDENCE AND PERSONAL DESCRIPTION
|
CITIZENSHIP, NATIONALITY AND RELIGION |
|||||||||||||||
1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | |||
|
Dwelling home |
Family, household or institution |
Name of each person in family, household or institution |
Place of habitation. Township or parish, city, town or village. |
Sex |
Relationship to head of family or household |
Single, married, widowed, divorced or legally separated. |
Month & day of birth |
Year of birth |
Age at last birthday |
Country or province of birth. (If in Canada, specify province or territory.) |
Year of immigration to Canada if an immigrant. |
Year of naturalization if formerly an alien. |
Racial or tribal origin. |
Nationality |
Religion |
||
1 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1 |
|
PROFESSION, OCCUPATION, TRADE OR MEANS OF LIVING |
WAGE-EARNERS |
INSURANCE HELD AT DATE |
|||||||||||||
17 | 18 | 19 | 20 | 21 | 22 | 23 | 24 | 25 | 26 | 27 | 28 | 29 | 30 | 31 | 32 | |
|
Chief occupation or trade |
Employment other than at chief occupation or trade if any. |
Employer |
Employee |
Working on own account |
State where person is employed, such as "on farm", in "woolen mill", "at foundry shop", "in drug store", etc. |
Weeks employed in 1910 at chief occupation or trade. |
W’ks employed in 1910 at other than chief occup’n. or trade, if any. |
Hours of working time per week at chief occupation. |
Hours of working time per week at other occupation, if any. |
Total earnings in 1910 from chief occupation or trade. |
Total earnings in 1910 from other than chief occupation or trade, if any. |
Rate of earnings per hour when employed by the hour |
Upon life |
Against accident or sickness |
Cost of insurance in census year. |
1 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
EDUC. AND LANGUAGE OF EACH PERSON 5 YRS. OF AGE AND OVER |
INFIRMITIES |
||||||||
33 | 34 | 35 | 36 | 37 | 38 | 39 | 40 | 41 | 42 |
Months at school in 1910 |
Can read |
Can write |
Language commonly spoken |
Cost of education in 1910 for person over 15 yrs. |
Blind |
Deaf or dumb |
Crazy or Lunatic |
Deaf and Dumb NOT to be entered |
Idiotic or Silly (Numbers given for above categories) |
|
|
|
|
|
|
|
|
|
|
Based On: Column headings: 1911 federal census return - [Source: http://www.archivecdbooks.ca/Samples/1911Census_V5.doc ]
To Interpret the Records, go to: http://www.collectionscanada.gc.ca/databases/census-1911/001003-1200-e.html