HOUSEHOLD RECORD OF BARANGAY INHABITANTSBusiness/House No. _________________________________Lightning SystemWater System: Place of Origin/Ethnic Origin:__________________________( ) Electricity ( ) Kerosene ( ) Solar ( ) Others: _____ ( )Spring ( ) Deep Well ( ) BWD ( ) water deliveriesDialect: ___________________________________________Source of information:Toilet Facilities: Housing Status:( )TV ( )Radio ( )Newspaper ( )Internet ( )Others:____ ( )Open Pit ( )Flush ( ) Others: _________________Type of House: ( ) Concrete ( ) Semi-concrete ( ) wood/bambooCommunication Services:Means of Transportation: ( ) 2 Stories ( ) 3 Stories ( ) 4 Stories ( ) 5 Stories( )Telephone ( ) Cellular Phone ( ) Internet ( )PUB ( )PUJ ( )Private Car ( )Others:__________Land Tenure/Ownership: ( )Telegraph ( ) Others: ________________( ) Owned ( ) on the process ( ) Private/Titled ( ) Others: __________House: ( ) Owned ( ) Rented ( ) Caretaker ( ) Others: __________Approximate income of the Family:Per month/year: _________________________________ NAMESEXCSBirth DateAGEPlace of BirthYearsStayedIn theBrgy.Relationship to Family HeadReg.Voter(Yes)(No)OccupationReligionHighest Educational Attainment

FAMILY NAMEFIRST NAMEM.I.