[] Yes, 10 acres or more
[] Yes, commercial establishment or medical office
[] No, none of the above

"A commercial establishment is easily recognized from the outside; for example, a grocery store or barber shop. A medical office is a doctor's or dentist's office regularly visited by patients. If your house is on a place of 10 acres or more and also contains a commercial establishment or medical office, mark Yes, 10 acres or more."

[] Yes, yearly cost is $____________.00
[] No, included in rent (Yearly cost)
[] No, these fuels not used