Having had more than my share of negative experiences in the Wolseley area, I am convinced that such a questionnaire will soon be required of each resident:
In accordance with the Neighborhood Character Preservation Act By-Law of 2011, the City of
now requires each current and prospective resident of the Wolseley area to submit this questionnaire and forward it to the Social and Demographic Registry. Please answer all questions and return a signed copy to the Registrar, Social and Demographic Registry, Winnipeg 510 Main Street, Winnipeg, MB R3B 1B9.
Section I: Personal Information
Current Address ____________________________________________________
Phone Number ____________________________________________________
E-mail Address ____________________________________________________
If you are prospective resident of the Wolseley area, please state address of proposed residence:
Social Insurance Number ______________________
Section II: Demographic Information
How many dogs do you own?
___ more than 4
Which party did you vote for in the last election?
___ Didn’t vote (incarcerated)
___ Didn’t vote (physically incapacitated)
___ Didn’t vote (other)
What is your occupation?
___ Social Activist
___ Child Care Worker
___ Social Worker
___ Bleeding Heart Socialist
___ Tree Hugger
___ Prostitute/Sex-trade Worker
___ Pimp/Sex-trade Broker
___ Drug Dealer
___ Car Thief
___ Slum Landlord
___ Welfare Bum
Favorite recreational activities (check all that apply)
___ Illegally jogging on roadway
___ Snorting/selling crack cocaine
___ Ingesting/selling methamphetamines
___ Injecting/selling heroin
___ Smoking/selling marijuana
___ Stealing cars
___ Vandalism (cars)
___ Vandalism (other)
___ Civil disobedience
___ Feeling sorry for the underprivileged
I have read and understand the Neighborhood Character Preservation Act, and I further understand that it is a serious offense to violate the Act and to have been untruthful in this questionnaire. As a condition of my acceptance for residency in the Wolseley area, I agree to periodic monitoring of my activities by the Registrar of the Social and Demographic Registry and/or his/her designate to ensure compliance with the Act. This may include, but not limited to the following: visual surveillance, wire tap of telephone conversations, sniffing Internet network traffic, periodic polygraph testing, and examining Manitoba Health and prescription records.
Signed at ________________ on this _____ day of ______________, _________.
Signature of resident (or prospective resident)
Signature of Witness (must not be blood relative of resident/prospective resident)
Name of Witness (please print) ______________________________
Address of Witness ____________________________________________________
Phone Number of Witness ______________________________________________