| Name and Surname | George Smith | Margaret Smith | Mary Baxter |
| Relation to Head of Family | Head of Family | Wife | Servant |
| Religious Profession | Church of Ireland | Church of Ireland | Roman Catholic |
| Education | Read and Write | Read and Write | Read and Write |
| Age | 29 | 30 | 26 |
| Sex | M | F | F |
| Rank, Profession or Occupation | Librarian | General Servant - Domestic | |
| Particulars as to Marriage | Married | Married | Not Married |
| Where Born | England | Belfat City | Cavan |
| Irish Language | |||
| Deaf, Dumb, etc. |
| County | |
| Parliamentary Division | East |
| Poor Law Union | Belfast |
| District Electoral Division | Ormeau Ward |
| Townland | |
| ?? | Belfast |
| City | Belfast |
| Urban District | Belfast |
| Town or Village | |
| Street | Ravenhill Road |
| Ward | Ormeau |
| Parish | Knockbreda |
| No of House | 244 | |
| Whether Built or Building | Built | |
| Private Dwelling etc | Private Dwelling | |
| Number of Out-Offices and Farmsteadings as returned on Form B.2 | ||
| Is House Inhabited? | Yes | |
| Particulars of Inhabited Houses | Walls | Stone, Brick or Concrete |
| Roof | Slate, Iron or Tiles | |
| Rooms | 10, 11 or 12 rooms | |
| Windows in Front | 5 | |
| Total | 12 | |
| Class of House | 1st. | |
| Families | No of distinct families | 1 |
| Name of the Head of each Family | George Smith | |
| Number of Rooms occupied | 10 | |
| Number of Persons in each Family | 3 | |
| Date on which Form A was collected | April 15th. | |
| Number of Persons who were sick on 2nd April 1911 | ||
| Name of the Landholder | ||
| No. of Form M.1 | ||
Source: www.census.nationalarchives.ie