Questionnaire Text

Questionnaire form view entire document:  text  image
c) IN THE PAST 12 MONTHS, what was the cost of water and sewer for this house, apartment, or mobile home?

If you have listed here less than 12 months, estimate the cost.

Past 12 months' cost - Dollars

$________________.00
OR
[ ] Included in rent or condominium fee
[ ] No charge

Questionnaire instructions view entire document:  text  image
14a-14d.
If your house, apartment, or mobile home is rented, enter the costs for utilities and fuels only if you pay for them in addition to the monthly rent.

If you live in a condominium, enter the costs for utilities and fuels only if you pay for them in addition to your condominium fee.

If your fuel and utility costs are included in your rent or condominium fee, mark the "Included in rent or in condominium fee" box. DO NOT enter any dollar amounts.

For items 14a and 14b, report last month's costs. For items 14c and 14d, report total costs for the past 12 months.

Estimate as closely as possible if you do not know exact costs. If you have lived in this house, apartment, or mobile home less than one year, estimate the costs for the past 12 months in 14c and14d.

Report amounts even if your bills are unpaid or paid by someone else. If the bills include utilities or fuel used also by another apartment or a business establishment, estimate the amounts for your house or apartment only. If gas and electricity are billed together, enter the combined amount in 14a and mark the "Included in electricity payment entered above" box in item14b.