Formulaire utilisé en 1870
(Disponible en anglais seulement)
Name of family
Occupation
No. of souls
Males
Females
Children
Infants
Equal to adults
Amount Sterling sent to Quebec for their use
£
s.
d.
Equal to currency
$
cts.
Amount paid by Quebec agent
$
cts.
Paid by …………… Agent
$
cts.