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If more than six persons live here, you will need an extra questionnaire; call 1-877-777-2011.
Please make sure that you have answered Questions 1 to 10.
2011 census
2A
STEP
1. How many persons usually live at this address as of May 10, 2011, including yourself?
F Complete online at
Include all persons who have their main residence at this address, even if they are temporarily away. STEP
You have now completed your questionnaire. Please mail it today. B See the instructions on page 3 (joint custody, students, permanent residents, secondary residence, etc.). 1. WHOM TO INCLUDE IN B
—
If you have lost the return envelope, please mail the questionnaire to: www.census2011.gc.ca Number of persons
Statistics Canada, PO BOX 99998, STN FED-GOVT, Ottawa, ON K1A 9Z8. • All persons who have their main residence at this address on May 10, 2011, including newborn babies, room-mates
2. Including yourself, list below all persons who usually live here. and persons who are temporarily away;
Thank you for your cooperation. Begin the list with an adult followed, if applicable, by that person’s spouse or common-law partner • Canadian citizens, permanent residents (landed immigrants), persons asking for refugee status (refugee
and by their children. Continue with all other persons who usually live at this address.
SECURE ACCESS CODE claimants), persons from another country with a work or study permit and family members living here with them;
FAMILY NAME GIVEN NAME • Persons staying at this address temporarily on May 10, 2011 who have no main residence elsewhere.
COMMENTS
Ce questionnaire est disponible en français 1-877-777-2011 Person 1
Prov. CD CU VN VR line no. CLD Forms 3 Questionnaire No. Person 2 2. WHERE TO INCLUDE PERSONS WITH MORE
of Person 3 THAN ONE RESIDENCE
• CHILDREN IN JOINT CUSTODY should be included in the home of the parent where they live most of the time.
Person 4 Children who spend equal time with each parent should be included in the home of the parent with whom they are
staying on May 10, 2011.
Person 5 • STUDENTS who return to live with their parents during the year should be included at their parents’ address,
even if they live elsewhere while attending school or working at a summer job.
Person 6 • SPOUSES OR COMMON-LAW PARTNERS TEMPORARILY AWAY who stay elsewhere while working or studying
should be listed at the main residence of their family, if they return periodically.
• PERSONS IN AN INSTITUTION for less than six months (for example, in a home for the aged, a hospital or
Person 7 a prison) should be listed at their usual residence.
Person 8
Visit www.census2011.gc.ca
0101 Page 8 PIB No.: STC/P-PU-005 STC/COP-015-03789 Page 2 or call 1-877-777-2011, 8 a.m. to 8 p.m. Page 3 0104
2 SEX
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
enough to conduct a conversation?
Mark “ inh” one circle only.
French only French only French only French only French only French only
Both English and French Both English and French Both English and French Both English and French Both English and French Both English and French
Example:
23 02 1974 enter best estimate.
For children under the age of 1,
8 (a) What language does this person speak
most often at home?
English English English English English English
Age 37 enter 0. Age Age Age Age Age Age
French French French French French French
Other — Specify Other — Specify Other — Specify Other — Specify Other — Specify Other — Specify
5 Is this person living with a common-law partner? Yes, French Yes, French Yes, French Yes, French Yes, French Yes, French
Yes Yes Yes Yes Yes Yes
Yes, Other — Specify Yes, Other — Specify Yes, Other — Specify Yes, Other — Specify Yes, Other — Specify Yes, Other — Specify
Common-law refers to two people who live together as a No No No No No No
couple but who are not legally married to each other.
6 RELATIONSHIP TO PERSON 1
Opposite-sex husband or wife
of Person 1
at
9 What
For each person usually living here, describe his or her Opposite-sex common-law is the language that this person first learned English English English English English English
relationship to Person 1. partner of Person 1
home in childhood and still understands?
Same-sex married spouse Son or daughter of both Son or daughter of both Son or daughter of both Son or daughter of both French French French French French French
Mark “ ” or specify one response only. of Person 1 Persons 1 and 2 Persons 1 and 2 Persons 1 and 2 Persons 1 and 2
X PERSON 1 If this person no longer understands the first language Other — Specify Other — Specify Other — Specify Other — Specify Other — Specify Other — Specify
Adopted children should be considered sons and daughters. Same-sex common-law Son or daughter of Son or daughter of Son or daughter of Son or daughter of
partner of Person 1 Person 1 only Person 1 only Person 1 only Person 1 only learned, indicate the second language learned.
Children in joint custody should be included in the home of Son or daughter of Son or daughter of Son or daughter of Son or daughter of Son or daughter of
the parent where they live most of the time. Person 1 only Person 2 only Person 2 only Person 2 only Person 2 only
Son-in-law or daughter-in-law Son-in-law or daughter-in-law Son-in-law or daughter-in-law Son-in-law or daughter-in-law Son-in-law or daughter-in-law
Children who spend equal time with each parent should be of Person 1 of Person 1 of Person 1 of Person 1 of Person 1
included in the home of the parent with whom they are Grandchild of Person 1 Grandchild of Person 1 Grandchild of Person 1 Grandchild of Person 1 Grandchild of Person 1
staying on May 10, 2011.
Father or mother of Person 1 Father or mother of Person 1 Father or mother of Person 1 Father or mother of Person 1 Father or mother of Person 1 If you are answering on behalf of other people, please consult each person.
10 This question is for all persons listed on the questionnaire.
For all children, please consider the relationship to Person 1
and Person 2.
Father-in-law or mother-in-law Father-in-law or mother-in-law Father-in-law or mother-in-law Father-in-law or mother-in-law Father-in-law or mother-in-law
If none of the choices apply, specify this person’s relationship of Person 1 of Person 1 of Person 1 of Person 1 of Person 1
to Person 1 under “ Other ”. Brother or sister of Person 1 Brother or sister of Person 1 Brother or sister of Person 1 Brother or sister of Person 1 Brother or sister of Person 1 Only if you mark “ YES ” to this question will your census responses and family history be part of the historical record of Canada.
A “ YES ” means your census responses will be available to family members and historical researchers, 92 years after the 2011 Census, in 2103.
Examples of “ Other ” relationships to Person 1: Foster child Foster child Foster child Foster child Foster child
If you mark “ NO ” or leave the answer blank, your census responses will never be made available to future generations.
• brother-in-law or sister-in-law Room-mate, lodger or Room-mate, lodger or Room-mate, lodger or Room-mate, lodger or Room-mate, lodger or
• niece or nephew boarder boarder boarder boarder boarder
• grandfather or grandmother
• room-mate’s son or daughter
Other — Specify Other — Specify Other — Specify Other — Specify Other — Specify
Does this person agree to make
his or her 2011 Census information
Yes Yes Yes Yes Yes Yes
• lodger’s husband or wife
available in 2103 (92 years after the census)? No No No No No No
• employee
• etc.
Visit www.census2011.gc.ca Visit www.census2011.gc.ca
or call 1-877-777-2011, 8 a.m. to 8 p.m.
Page 4
Unfold HERE Page 5 0103 or call 1-877-777-2011, 8 a.m. to 8 p.m.
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