1. No. of House or Building.

2. Whether Built or Building.

3. State whether Private Dwelling, Public Building, School, Manufactory, Hotel, Public-house,
     Lodging-house, or Shop, etc.

4. Number of Out-Offices and farm-steadings as returned on Form B. 2.

5. Is House Inhabited. Yes or No, as the case may be.

6. Walls. If Walls are of Stone, Brick, or Concrete enter the figure 1 in this column; if they are of
    Mud, Wood, or other perishable material, enter the figure 0.

7. Roof. If Roof is of Slate, Iron, or Tiles enter the figure 1 in this column; if it is of Thatch, Wood or
     other perishable material, enter the figure 0.

8. Rooms. Enter in this column;- For each House with 1 Room only; the figure 1. For Houses with 2, 3 or
    4 rooms--2. 5 or 6 rooms--3. 7, 8 or 9 rooms--4. 10, 11 or 12 rooms--5. 13 or more rooms--6.

9. Windows in Front. State in this column the exact Number of Windows in Front of House.

10. Tot the Figures you have entered in columns 6, 7, 8 & 9 and enter the Total for each House in this
       column.

11. Class Of House. When Total in Col. 10 is 1 or 2 enter "4th". 3, 4, or 5 enter "3rd". 6, 7, 8 , 9, 10 or 11
      enter "2nd". 12 or over enter "1st".

12. No. of distinct Families in each House.

13. Name of the Head of each Family residing in Dwelling.

14. No. of Rooms occupied by each Family. See Note B. at foot.

15. Total Number of Persons in each Family.

16. Date on which Form A was collected.

17. Number of Persons in each Family who were sick on 22nd March 1901.

18. Name of Landholder, if any on whose Holding the house is situated, whether that name appears
on Column 13 or not.

19. No. on Form M. 1 if Home is on the Holding of a Landowner.