| 1 | Dwelling House. |
Numbered in the Order of Visitation. |
| 2 | Family or Household. | |
| 3 | Name of each person in family or household on 31st March, 1901. | Personal Description. |
| 4 | Sex. | |
| 5 | Colour. | |
| 6 | Relationship to head of family or household. | |
| 7 | Single, married, widowed or divorced. | |
| 8 | Month and date of birth. | |
| 9 | Year of birth. | |
| 10 | Age at last birthday. | |
| 11 | Country or place of birth. (If in Canada specify Province or Territory and add "r" or "u" for rural or urban as the case may be). | Citizenship, Nationality and Religion. |
| 12 | Year of immigration to Canada. | |
| 13 | Year of naturalization. | |
| 14 | Racial or Tribal origin. | |
| 15 | Nationality. | |
| 16 | Religion. | |
| 17 | Profession, occupation, trade or means of living of each person. (If person has retired from profession or trade add "r" for retired). | Principal Profession or Trade. |
| 18 | Living on own means. | |
| 19 | Employer. | |
| 20 | Employee. | |
| 21 | Working on own account. | |
| 22 | Working at trade in factory or in home. (Specify by "f" for factory and "h" for home, or both, as the case may be). | Wage Earner. |
| 23 | Months employed at trade in factory. | |
| 24 | Months employed at trade in home. | |
| 25 | Months employed in other occupation than trade in factory or home. | |
| 26 | Earnings from occupation or trade $. | |
| 27 | Extra earnings (From other than chief occupation or trade) $. | |
| 28 | Months at school in year. | Education and Language of each person five years of age or over. |
| 29 | Can read. | |
| 30 | Can write. | |
| 31 | Can speak English. | |
| 32 | Can speak French. | |
| 33 | Mother tongue (If spoken). | |
| 34 | a. Deaf and dumb. b. Blind. c. Unsound mind. |
Infirmities (If infirmities date from childhood add "from childhood"). |
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