Questionnaire Text

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Individual 01
Householder:
[] 1 Present
[] 2 Temporarily absent

If temporarily absent, is this person now:
[] 3 In this municipality or Commune
[] 4 In another municipality or Commune or Abroad (If the latter, specify the name of the country.)

(Indicate)
___ Municipality or Commune
___ Province or Foreign country
___ Reason for absence