F O R LI-C I CONFIDENTIAL FOR Fv1 -CI CONFIDENTI A L 1 IDENTIFYING NUMBER r-7-u- 23 VIORKED 0 2C -- RELATIONSHIP TO HEAD OF HOUSEHOLD G 7 AGE ( I N COMPLETED YEARS) 8 MARITALSTATUS (14 YEARS AND OVER) I (a) USUAL R ES1D ENC E 1::: (b) LOCAL OR FOREIGN FOREIGN COUNTRY & o o 3% 0 O o CltAT PJG 0 CALL 0 0 DO;.lESTIC ELlPL / R E L OTHER IIOT STATED O O O & 4% VI I D OVI E D I.1ARRIED O S O F KIP1 DOARDER/ REL u FEhlALE T H I S HOUSEHOLD KIN 0 OTHER REL u & O O (bl ~ I ---- RACE 12 RE LIG ION (c) 0 ELSELIIERE 111 CDUllTRY URI 0 0 o GEOTII 0 D'DOS 0 GREN 0 OTHER CARIB 0 0 URI 0 COL 0 GEOTII 0 HO'jE DUTIES 0 RETIRED 0 DISABLED 0 f:OT STATED 0 OTHER 0 H A S OVIN ßUSINESS/FARr,l PRIV EFITER 0 PRIV H ' t0 iOLD UPJPAID VJORKER 0 1 2-3 0 4-5 0 t L 1% 2% 3, 3", 0 STUDEflT 0 MITH P A I DO HELP V//OUT P A I0 D HELP DID O rio KORK 6-7 8-9 10-11 i"u 5, L llOT AF?LICAGLE 7, fl.3KOT STATED 9 3 4% g 0 O 12 I!OT 0 STATED O O IdOTSTATED O IIOT STATED O ABROAD COL 0 WA!JTED \ / O R K AIID AVAILASLE 0 9% 0% 7 5 LEGALLY SEP O D1 VOR C ED SG 0 hlARR ES USA 0 CHAT CAPI 0 r.1 G S O F KIN 0 CALL 0 0 CAPI 0 GRElI 0 USA 0 ST LUC 0 VCPJ 0 JAtl 0 Fl'/ I 0 T L T 0 OTHER CARIB 0 U'DOS 0 DY1 I 0 AIIT 0 tIEGRO/ ULACK 0 EAST Ir!DIArJ 0 CtiItIESE 0 AI.lER IlJDIAIJ 0 PORTU GUESE 0 SYRlArU LEU 0 VitilTE 0 DISTRICT LAST LIVED IN NUMBER OF DISTRICTS EVER LIVED IN 16 O (a) K I N 0 o PIOT STATED o SAFI U A Y 0 PIOT STATED O BARR 0 LAY 0 ... ..__. , -- 18 D0',1 12 APIGL 0 J E t i VdlT ATTENDANCE A T SCHOOL OR UNIVERSITY (a) 19 HIGHEST LEVEL OF 1") (bl TYPE OF SCHOOL/UNIVERSlTY YEARS OF SCHOOLING EXAM PASSED -- O r!OT STATED LAY 0 O UARR 0 0 r+:OYT 0 ALL OTHER 0 STKRI 0 FiOT STATED 0 GUY 0 r.lIXED 0 OTHER RACES 0 SAFI U A Y 0 O L A KllJ 0 O IIG 0 S O F KIN 0 CALL 0 l8 19 (a) 19 0 0 O COL 0 GEOTN 0 SNI B A Y 0 LAY 0 1 2 8 0 5 0 7 0 3 0 c 0 0 0 0 1970-72 1973-74 1975 197G 1977 1970 1979 4 - IJSRYI IrJFAPIT 0 F U L L TII.1E STUDEtJT O ~ PRl I.1ARY 0 PART T l l l E ST U D E I.JT O rJOFJE 0 rSRY / IrJFAPJT 0 A 1-2 PRl- MARY 0 . SECO:!D OR COLlP 0 LIULTI HIGH 0 ~ OTHER SECOFJD 0 , U?JIV 0 1XO ~ 0 I.;ULTI HIGH 0 9 OR r'ORE 0 r:OT STATED .- OTHER 0 OTHER S E C O ~ J D UrJiv 0 0 0::';JED ~ 22 ~ o_, 0 PUB PIPED IPITO DLIEL STATED O P!OT STATED O I:OT STATED O OTHER 0 7 8 o 10 11t 0 GCE(O)5/ SCI GCE(A)I 0 0 0 0 0 t!OT STATED 0 GCE(A) 2+ 0 DIP 0 DEG 0 OTtiER 0 IIOT STATED 0 U O 39(a) 22 PERIOD OF TRAINING (FOR PERSONSCVHOSETRAIPJING HAS BEEN COMPLETED) B æ - 22 UNDER ' 0 _c____ %-1 YEAR 0 1-1% YE 0 ARS 1%-2 Y0 RS 2-2% 0 2 x 4 34% 3x4 4-4% YRS 0 YRS 0 0 0 4%YRS 'OVER 0 RErJT FREE SQUATTED HP 0 0 0 0 ~ PU3 PIPED IrlTO Y D 0 0 1920 1979 1970 0 - PRIV CATCHV f:OT PIPED O ~ 0 PIT 0 1970-77 O 0 CALL 0 (b) OTHER GAS o l o ELSEYIHERE IFJ COUPJTRY O SG 0 hlARR URI 0 0 OTHER ~ puB TANK 0 LINKED TO SEVIER 0 ~ OTHER COL 0 COOKING ELEC o o O 0 \'I C I I O T LllJKED TO SEVIER f:OT STATED O f:OT STATED OTHER lOC0 OR EARLIER lDSl-C[f LIG H T l NG KEROSENE ELEC O O THIS HOUSEHOLO O CHAT N G S O F KlrJ 0 0 PU3 STArID PIPE CD 63(a) GOVT RENTED V/C I:ONE O * PRIV PIPED IIJTO DWEL SHARED (4(a) B PRIVATE RErJTED 0 I:OT SHARED KIN 0 METHOD BY WHICH VOCATIONAL TRAINING ACQUIRED LEASED JI t! OT PIOT APPLI CABLE O SECOrdD ORCO".:P UARR 0 24(b) 21 O O F:OT STATED URI 3-4 5-6 0 0 0 PCE/ CP/ 19 SCHOOL C H S D I P I GCE(o) ( c ) IjOTJE L E A V l r J G SSpE 1-4 0 0 0 0 CXC(U)1-3 CXC(G) 1-3 (b) ,o ADVTST 0 0 r:O:JE IIOTSTATEC UEFORE IJONE 0 e, 32 $:; RO:.lArI CATH SG 0 IslARR 15 17 F:OT STATED 0 L ; ) 3 3 , b k 3 L 7 3 b ? 3 CtlAT u I STATED FIOT CHURCH PRESBY/ OF UAPTIST tllrdDU GOD I.lETHDST I*!ORAVIJ PElJT COIJGR 0 0 0 0 0 0 0 URETH SAL A R ' l Y A r.1 E (21Ot1) I,lUSLlr+l I.lErdr;ONITE OTHER o, -~ - 0 I,lARR OTttER COUPIT 0 11 1970 TYPE OF SCHOOL OR UNIVERSITY NOW BEING ATTENDED 0 T G T 0 SG 10 (b) lG YEAR OF IMMIGRATION __ap____- - U 1: 0 10 14 14 E DUCAT1ON A L ATTAINMENT (INCLUDING PERSONS STILL A T SCHOOL) o IJEVER I.lARRlED , 11 15 SPOUSE/ PARTIJER 0 DTHELS SEEKI:IG \:'ORK 0 9 DISTRICT IN ST. VINCENT j(b) 7, 9(a) DISTRICT IN ST. VINCENT CHILD OF HD/S? S I A L E 0 9 FOREIGN COUNTRY BIRTH PLACE HEAO 0 u SEX 9 25 5 JOE V/ORKED F O R OTHERS O GOVT 5 SEEKIfiC FIKT f'OT STATED OTttER/ V,,OODI CHAR o KERO o P:ONE o AUHOAO O NOT STATED O GEOTrJ 0 SArJ U A Y 0 LAY 0 BARR 0 P - 23 P A S T Y I I I - Y U I Y Y Y Y _ A _ * . I" L I *-L-yL 23 M A I N ACTIVITY DURING PAST 12 MONTHS 2.: 24 WORKER OR OCCUPATIONAL STATUS DURING PAST YEAR 25 SE E K I I:G OTti E TbS \ :A:l TE 0 FIRST SEEKI::C \/ORK AIJO JOB \,ORK AVAILASLE \.;ORKED 0 0 0 0 \'IORI<ED FOR OTHFRS PRIV PRIV UtIPAID GOVT EIJTER t i ' t i O L D \;ORKER O 0 25 MONTHS WORKED DURING PAST 12 MONTHS 0 2-3 1 O 1iO::E OUTIES 0 STUOEIJT 0 RETIRED 0 DISACLED 0 OTHER 0 r.OT STATED 0 HAS 01'lN RLJSlNESS/FARI<l VIITti P A I D HELP O 0 O 4-5 O G-7 O LOOKED FOR\iK 0 t101AE DUTIES 0 STUDEIIT 0 8-9 VIIOUT PAID IiELP DID O 12 10-11 O O IJOT STATED 0 rio \:ont: 0 O rJOTSTATED O 26 M A I N TYPE OF JOB OR OCCUPATION DURING PAST 12 MONTHS (WRITE AS GIVEN) (;:c,-í 2;:':!#-8 . - U L L CiK.,') I iLL Y E - l ' I ' - 27 INDUSTRY OR TYPE OF BUSINESS DURING PAST 12 MONTHS (WRITE AS GIVEN) R - 'W28 4E SE 29 r I( ~ ~~~ O, 29 & 4% !& OlSAeLEO 0 OTHER 0 6% !;OT STATEO O 8% 7% n3 u NUMBER OF LIVEBORN CHILDREN EVER HAD a, 31 LIVEBORN CHILD AGE 2& 1% RETIRED 0 ~~~~ 31 AGE O F MOTHER A T BIRTH OF FIRST 32 \,ITtI JOß I:OT\vKC 0 \#ORKED 0 TOTAL NUMBER OF HOURS WORKED (INCLUDING OVERTIME) DURING PAST WEEK ~~ 30 20 ECONOMIC SITUATION DURING PAST WEEK OF MOTHER A T BIRTH O F LAST ,o 23 & 2& t a, ,o 32 L L 2% L 63 3, LL & 4% 3, Q3 & 4% I:OT AFPLICACLE O 43 ti, & 33 7 3 0 . 3 7 3 I:DT STATED O l i O T AFPLICACLE ,9 0 3 liOT STATED O O LIVEBORN CHILD 33 34 35 36 NUMBER O F L I V E BIRTHS/STILLBIRTHS DURING PAST 12 MONTHS ~ 34 UNION STATUS-AT PRESENT OR A T AGE 45 LAV/ SEP HOUSE FLATI APTI.1T 0 0 0 0 LEASED 0 PRIVATE REIJTED 0 RErJT FREE 0 36 TYPE OF DWELLING 0;';IIED 0 ZD WATER SUPPLY PUD PIPED IiJTO DVIEL O 39(4 39 TOI LET FACI LlTlES 41 42 43 ~KL~(::D 37 TYPE OF TENURE 40 VISITING PdO LOIJGER L l V l l J G VJITH C L. PARTrJER PJEVER H A D HUS3 O R C L.PARTNER IjOT STATED DURATION OF UNION (COMPLETED YEARS) 37 38 PJO LOrJGER LIVIPJG V I l T t i t I US3 A N O co ?>? 11. o f 1 I.1ARRIED 1: 0 SHARED I:OT SHARED O 0 PT O F PRIV PIPED lfJTO DVJEL 0 0 0 0 SQUATTED 0 HP 0 GOVT RENTED 0 PRIV. CATCH:.l lJOT PIPED PU3 STAND PIPE PUU. TArJK O 0 (b) P:ONE 0 VJ C LINKED T O SEVJER PIT O 0 0 F I ~ ~ D STATED l.OT ADODE 0 O IiOT STATEO OTHER 0 O LOT STATEO O OTHER 0 \'I C PJOT LlfJKED T O SEVIER 0 OTIlER 0 19CO OR 1920 0 1979 0 1970 0 1970-77 0 19Gl-G9 0 ViOOD COIJCRETE STOIJE DRICK IJOG 51 MATERIAL OF OUTER WALLS OTHER GROUP PRIV. DVIELLIr:G R00:.1 O YEAR WHEN DWELLING BUILT NUMBER PUD PIPED IrlTO Y D '*IJGEO U T f:OT STATEO O EARLIER O VIATTLE, VÀONODD ADODE ßRIC{( Vi000 AtJD CONCRETE OTHER IJOT STATED OF ROOMS TYPE OF LIGHTING/FUEL USED FOR COOKING 44 INDIVIDUAL SPEND CENSUS NIGHT [(a) LOCALLY OR ABROAD (bl DISTRICT I N ST. VINCENT , 43(5) ELEC O LIGHTING t<E RO S EN E O (b) OTHER 0 GAS 0 C O O K I N G i',OOD1 ELEC 0 CHAR 0 OTtiEW KERO 0 I:OIJE 0 I N S Ï R UCT I ONS l. Pleas2 usc the #2 black-lezd pencil supplied when marking your znscvers to the questions on this form. DO N O Ï USE INI:, BALLPOINT PEN, OR COLORED PENCIL. I f you malte a mistalte, erase cleanly End then fill in the answer spaca you want. Be sure to fill a response position ( 0 ) for each question where the question applies to the individual. Each answer space you mark should b e filled in completely with a b l a c k marl:, the same 2s shown in the SAMPLE QUESTION. S A M PL E QU EST I O IU EXAMPLE OF HOW TO ANSWER THE QUESTIoNS LESS THAPJ hlORE TIIAIJ Ah:OrJTtIAGO O MAKE NO EXTRANEOUS MARKS O F ANY KIND ON THE FORM 2. Do not marl: or vlrite in the shaded areas. The areas will be marltcd in the central office. 3. When you have f i n i s h d questions 1 through 22, carefully fold a t perforation and continue with questions 23 through 443. 4. Try t o make your marks ES shown here: t=j Do not malte them too light 0 or too thin A readable mark Too light or poorly erased Mark too short too short too long An ideal mark -.+ Mark too long Too thin to read
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