LIST of the Members of the Household or Family, Visitors, Servants, and Others, who Slept or Abode in this Dwelling on the Night of Sunday, the Seventh of April, 1861.

	NAME AND SURNAME.	RELATION TO HEAD OF FAMILY.	CONDITION.	SEX.	AGE (LAST BIRTHDAY.)	RANK, PROFESSION, OR OCCUPATION.	HEALTH.	WHERE BORN.	RELIGION.	EDUCATION.	DESCRIPTION OF DWELLING.*
	No Persons absent on the night of Sunday, the 7th April, to be entered.Write after the Name 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, of other Relative, Visitor, Lodger, or Servant.	Write"Married, " "Widow," "Widower,"or"Unmarried,"against the Names of all Persons, except Young Children.	Write"M"against Males, and"F"against Females.	The Age of persons over One Year to be given in years only (last birthday),but 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 unable to follow usualoccupation by a reason of illness or accident, write "Sick," or "Accident," or if afflicted by incurable infirmity write "Deaf and Dumb," or "Blind," as the case may be.	State the Country, not the Town or Prish ; 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," "Presbyterian," &c.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. [Any Pesons having conscientious scruples to fill up this column, will insert there in the word "object."]	Insert degree of Education, that is,"Cannot Read," "Read only," or "Read and Write."as the case may be ; and state if a Member of any University.	Stone, Brick, Wood, Linen, &c., and number of rooms, including kitchen.
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