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 day of 1871.

Name and Surname.	Relation to Head of Family.	Condition.	Sex.	Age (Last Birthday.)	Rank, Profession, or Occupation.		Health, &c.	Where Born.	Religion.	Education.	Description of Dwelling.	Land in Occupation.
					Present.	Past.
No person absent on the night of Sunday the to be entered.	State whether Wife, Son, Daughter, or 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.]	[Only to be filled by persons who are now pursuing a different calling from that they have been brought up to.]	If unable to follow usual occupation by reason of illness or accident, write" Sick"or" Accident."or if afflicted by either of the following infirmities write" Deaf and " Dumb," " Blind," " Lunatic," " Idiot," or " Epileptic,"as the case may be.	State the Country, 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 Religous Body, as " Cacholic," " Protestant" " Presbyterians," &c.	Insert Degree of Education, that is "Cannot[Illegible] ," "Read only,"or "Read and Write,as the case may be ; and state if a Member of any University.	State whether built of Stone, Brick, Wood, Line, &c., and number of rooms, including kitchen.	(Only to be filled at holdings of more than one acre in extent.)
Write after the name of the Head of the Family the names of his wife, Children, and other Relatives ; then Visitors, Lodgers, Servants, &c.		[Chinese to be set down as unmarried unless they other have or have had wives in Australia.]						[" C" for " Chinese, " Ab" for aboriginal, to be inserted after the words " China" or " Victoria" if the person referred to is a member of either race.]	(Presbyterians are especially directed to state to what particular section of the Presbyterian Church in Victoria they adere.)	[Chinese to be set down as " unable to read and write" unless they can read and write English.]
									If 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 borught up.
									[Any person objecting to fill up this column will insert therein the word " object."]
1										In Cultivation	acres.
2
3
4
5
6
7
8
9
10
11
12
13
14
15