A. Geographic location
1. Department ____
2. Region no. ____
3. Judicial section no. ____
4. Segment no. ____
5. Zone no. ____
A. [Is it ...?]
[] 1 Urban
[] 2 Suburban
[] 3 Rural
B. Divided into blocks:
[] 1 Yes
[] 2 No
6. Dwelling type
[] 1 Private home
[] 2 Collective
7. Populated nucleus
____ Name
____ Category (write down if it is a city, village, town etc.)
8. Address
Urban:
____ Street
____ No.
____ Floor no.
____ Apt. no.
Rural: ________
9. Control sheet line no. ____