Questionnaire Text

Questionnaire form view entire document:  text  image
f. A stove or range?
[] Yes
[] No
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.

8f. Mark "yes" to "a stove or range" if the stove or range is inside the house, apartment, or mobile home. Portable cooking equipment is not considered a stove or range.