Mar. 11.] THE NEW ZEALAND GAZETTE. 611

Census of 1926.

THE annexed forms, which are hereby published for general information, show for each Schedule to be used in the Census of 20th April next the information required to be furnished by occupiers and other persons under the Census and Statistics Act, 1910, and regulations thereunder.

RICH. F. BOLLARD,
Minister of Internal Affairs.

HOUSEHOLDER’S DWELLING SCHEDULE.

1. NAME of dwelling, vessel, institution, &c.
2. (a.) Name of locality where establishment situated.
   (b.) If establishment not situated in a town, name of nearest post-office and distance from it (by road or rail, &c.) in miles.
   (c.) If householder or occupier and family do not ordinarily reside in this town or district, state where habitually resident, giving name of borough, town district, or county; or, if outside New Zealand, give name of country only.
3. (a.) Whether dwelling erected for permanent or temporary residential purposes.
   (b.) Whether a structurally separate private dwelling, self-contained flat, apartments with or without use of conveniences, rooms attached to shop, &c., rooms in an institution, boarding-house, hotel, vessel, public or private institution, &c.
   (c.) In the case of flats or apartments state “Yes” or “No” whether situated in a building or portion thereof built and designed for that purpose only.
4. Number of rooms in the establishment.
5. Tenure on which the establishment is held.
6. Amount of weekly rent paid, or, if not rented, weekly rental value (unfurnished).
7. Material of which outer walls of establishment are built.
8. Number and names of persons who passed the night of 20th April, 1926, within the establishment, or arrived on the 21st April without having been enumerated elsewhere.
9. (a.) Ages of members of the householder’s family (related by blood, marriage, or adoption) ordinarily resident in the dwelling but absent at census.
   (b.) Numbers of persons (not being members of the family) ordinarily resident in the dwelling, but absent at census.

CENSUS OF POULTRY.

Numbers of fowls, ducks, geese, and turkeys.

DECLARATION.

I hereby certify that this Householder’s Dwelling Schedule (Census-6) is correctly and completely filled up to the best of my knowledge and belief, and I also certify that the accompanying Householder’s Family Schedule (Census-7) and/or Personal Schedule(s) (Census-8) cover each and every individual who passed the night of the 20th April, 1926, within this establishment, or arrived on the 21st April, without having been enumerated elsewhere.

[Signature of householder or person in charge.]

HOUSEHOLDER’S FAMILY SCHEDULE.

1. NAME and surname of every member of the family (being related by marriage, blood, or adoption to the householder or occupier) who is ordinarily a resident in the household and who passed the night of Tuesday, 20th April, 1926, in the dwelling and was alive at midnight, or arrived in the dwelling on Wednesday, 21st April, not having been enumerated elsewhere.
2. Relation to head of family.
3. Sex.
4. Age at census date, in years and completed months.
5. Conjugal condition and orphanhood.
6. Number of living children (including step-children and adopted children) under sixteen years of age of each married man, widower, and widow entered on this Schedule.
7. The industry, trade, or service in which engaged.
8. Personal occupation followed at date of census, or if then unemployed, the usual occupation.
9. Grade or status of employment.
10. Number of working-days lost during the twelve months immediately preceding the census,—
    (1.) Through sickness, accident, or injury—
    (a.) Received in course of employment.
    (b.) Received otherwise than in course of employment.
    (2.) Through lack of employment not due to strikes or lock-outs.
11. Length of residence in New Zealand.
12. Race.
13. Religious profession.
14. Incomes per annum. Enter N I if no income; A if under £52; B if £52 and under £156; C if £156 and under £208; D if £208 and under £312; E if £312 and under £364; F if over £364.

DECLARATION.

I declare that this Householder’s Family Schedule (Census-7) is completely and correctly filled up to the best of my knowledge and belief.

[Signature of householder or person in charge.]

PERSONAL SCHEDULE.

1. Name and surname.
2. Address on census night.
3. Relationship to head of household or establishment.
4. Sex.
5. Age at census date in years and completed months.
6. (a.) If age sixteen or over, state whether “never married,” “married,” “widowed,” “divorced,” or “legally separated.”
   (b.) If under age sixteen, state if father and mother both living, if father dead, if mother dead, or if both dead.
7. If a married man, widower, or widow, state number of his or her living children under age sixteen, including step-children and adopted children, if any.
8. The industry, trade, or service in which engaged.
9. The personal occupation followed at date of census, or if then unemployed, the usual occupation.
10. Grade of occupation.
11. Number of working-days lost during the twelve months immediately preceding the census,—
    (1.) Through sickness, accident, or injury.
    (a.) Received in course of employment.
    (b.) Received otherwise than in course of employment.
    (2.) Through lack of employment not due to strikes or lock-outs.
12. Length of residence in New Zealand.
13. Race.
14. Religious profession.
15. If away from home the usual place of residence, giving, if in New Zealand, the name of county, borough, or town district. If a resident of another country, give name of country only.

INCOME PER ANNUM.

16. Mark X in the square under the category in which your income falls.

DECLARATION.

I declare that this Schedule is completely and correctly filled up to the best of my knowledge and belief.

[Signature.] [Address.]

MAORI SCHEDULE.

1. FULL name of every person or child who passed the night of Tuesday, 20th April, in the dwelling or arrived on Wednesday morning without being included in the census elsewhere.
2. Sex.
3. Race: Maori full blood, half-caste, three-quarter-caste, &c., as the case may be.
4. Age.
5. Marriage: Write “Never married,” “married,” “widowed,” “divorced,” or “legally separated,” as the case may be.
6. Trade or occupation.
7. Religion.
8. Usual residence: If not ordinarily living in this district, give home address.
9. Dwelling—
   (a.) Address of the dwelling.
   (b.) Whether a house, boardinghouse, tent, camp, &c.
   (c.) Number of rooms in the dwelling.
   (d.) State whether you own or rent the house.

Person filling in this Schedule must sign below to show the statements are complete and correct to the best of his knowledge and belief.

[Signature.]

AGRICULTURAL AND PASTORAL STATISTICS.

OCCUPIER’S SCHEDULE.—BOROUGHS.

1. Name of occupier.
2. Postal address.
3. Borough.
4. Number of hands ordinarily employed on the holding.