Questionnaire Text

Questionnaire form view entire document: text image

Housing (continued)

B Answer questions 18a and b if this house, apartment, or mobile home is rented. Otherwise, skip to question 19.

21. What is the annual payment for fire, hazard, and flood insurance on this property?

Annual amount - dollars
_ , _ _ _
or
[] None

Questionnaire instructions view entire document: text image

Answer questions 1 through 21 for the house, apartment, or mobile home at the address on the mailing label.

Answer housing questions 19 through 23 only if you or any member of this household owns or is buying this house, apartment, or mobile home.

21. When premiums are paid other than on a yearly basis, convert to a yearly basis. Enter the yearly amount even if no payment was made during the past year.