| No .................. | .................................. Quarter. |
| Name ......................................................... |
| Description ................................................... |
| Area .......................................................... |
Situation and Boundaries
of the property |
Number and particulars of
houses on the property |
Nature and Extent of Cultivation
if any |
| Sugar Cane. | Acres .............. | Cocoa. | Acres .............. |
| Limes. | Acres .............. | Cotton. | Acres .............. |
| Citrus (except Limes). | Acres .............. | Bananas. | Acres .............. |
Ground provisions
and Vegetables. | Acres .............. | Coffee. | Acres .............. |
| | Coconuts. | Acres .............. |
| Forest. | Acres .............. | Pasture. | Acres .............. |
| Other cultivation not enumerated (State name of crop or crops.) | Acres .............. | | |
| Area not cultivated. | Acres ................ | | |
| Area not cultivable (Reason for this in brief). | Acres ................ | | |
| Animals. |
| Cows and Heifers .......... | Bulls and Oxen ............ | Sheep ............ |
| Goats ....................... | Pigs ........................ | Horses ........... |
| Mules ...................... | Asses ...................... | Poultry ........... |
| | Rabbits .......... |
| Name and address of the owner of the owner of the property | .................................. |
| Name of person, in occupation and whether as owner, tenant, manager, or otherwise | ............................... |
| I .............................. of ...................................... do hereby declare that I am the person in possession of the abovementioned property in the District, and the particulars above appearing fully and truly set out the information required by the Statistics Act to the best of my information, knowledge and belief. |
| Dated this .................... day of .............................., 20.......... |
| Witness .......................................... (Signature) ....................................... |
| N.B.—Any person who neglects or refuses to make a Return or makes any untrue Return as to any of the matters required by the Statistics Act commits an offence under that Act. |