Literal question
[Image of Royal Arms omitted.]</p>
<p><span class="h3">Householder's schedule</span></p>
<p>Prepared under the direction of one of Her Majesty's Principal Secretaries of State, pursuant to the Act of 33 and 34 Vict. c. 108.</p>
<p>The following compartments are to be filled up by the Enumerator.</p>
<div class="i1">Registration district ________<br />Parish ________<br />City, town, village, or hamlet ________<br />Street, square, etc., or road ________<br />Name or number of house ________<br />Number of rooms with one or more windows ________<br />Name of occupier ________</div>