Questionnaire Text

Questionnaire form view entire document: text image

10. Does this house, apartment, or mobile home have COMPLETE kitchen facilities: that is, 1) a sink with piped water, 2) a stove or range, and 3) a refrigerator?

[ ] Yes, has all three facilities
[ ] No

Questionnaire instructions view entire document: text image

10.The kitchen sink, stove, and refrigerator must be in your house, apartment, or mobile home but do not have to be in the same room. Portable cooking equipment is not considered a range or stove.