LIST of the Members of the Household or Family, Visitors, Servants, and Others, who Slept or Abode in this Dwelling on the Night of the first day of May, 18

	NAME AND SURNAME.	RELATION (IF ANY TO HEAD OF FAMILY.	CONDITION.	SEX.	AGE LAST BIRTHDAY.	RANK, PROFESSION, OR OCCUPATION.	WHERE BORN.	RELIGION.	EDUCATION.	DESCRIPTION OR DWELLING.
	No Person absent on the Night specified to be entered.Write after the Names of the Head of the Family, the Names of his Wife, Children, and other Relatives ; then Visitors, Lodgers, servants, &c.	State whether Wife, Son, Daughter, or other Relative, Visitor, Lodger, or Servant.	Write" Married,"" Widower,"" Widows,"or "Unmarried."against the Names of all Persons, except Young Children.	Write" M "against Males, and" F "against Females.	The Ages of Infants under One Year to be stated inMonths.	(Before filling in this Column, you are requested to read the instructions on the other side.)If from sickness of accident unable to follow usual occupation, write" S "for sickness, and" A "for accident, after the occupation.	State the Country or Colony, not the Town or Parish ; If born in Foreign Parts, or at Sea, add whether a British Subject by Parentage or Naturalization ; if in Australia, state which Colony.	State the Name of the Religion or Sect. Do not use general terms that represent more than one Religious Body, as" Catholic," " Protestant,"die. If of no Denomination, or if the Religion cannot be ascertained from the occupier or person in charge, state so. Write against the names of Children, however young, the Religion in which it is intended they are to be brought up.	Insert degree of Education, that is" Cannot read,." " Read only," " Read and Write,"or as the case may be ; and state if a Member of any University.	Wood, Stone, Brick, Linen, &c.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15