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How many bedrooms do you have; that is, how
<br />many bedrooms would you list if this house,
<br />apartment, or mobile home were on the market
<br />for sale or rent?
<br />No bedroom
<br />~ 1 bedroom
<br />0 2 bedrooms
<br />3 bedrooms
<br />0 4 bedrooms
<br />~] 5 or more bedrooms
<br />• Do you have COMPLETE plumbing facilities in this
<br />house, apartment, or mobile home; that is, 1) hot
<br />and cold piped water, 2) a flush toilet, and 3) a
<br />bathtub or shower?
<br />~ Yes, have all three facilities
<br />No
<br />
<br />Do you have COMPLETE kitchen facilities in this
<br />house, apartment, or mobile home; that is,
<br />1) a sink with piped water, 2) a range or stove,
<br />and 3) a refrigerator?
<br />~ Yes, have all three facilities
<br />0 No
<br />Is there telephone service available in this house,;" ..
<br />apartment, or mobile home from which you cad:.{,, ',
<br />both make and receive calls? `~`~
<br />t\
<br />Yes ~ - ~'
<br />`:fi`~~ i
<br />No -~ , `~~
<br />Which FUEL is used MOST for heatirths house,
<br />apartment, or mobile home? %~ ~:~; j;,
<br />~ ~~.~. }1
<br />~ Gas: from underground pi~es;seruitig
<br />the neighborhood ~• `:~
<br />~,:
<br />Gas: bottled, tank, ot'~-,`
<br />.,~ ~.,
<br />~ Electricity ~,
<br />Fuel oil, kerosene, etc. `~
<br />0 Coal or coke
<br />Wood
<br />Solar energy
<br />Otherfuel
<br />~ No fuel used
<br />How many automobiles, vans, and trucks of
<br />one-ton capacity or less are kept at home for use
<br />by members of your household?
<br />0 None
<br />1
<br />2
<br />3
<br />4
<br />5
<br />6 or more
<br />IIIIIIIIIIIIII
<br />Answer ONLY if this is aONE-FAMILY HOUSE
<br />OR MOBILE HOME -All others skip to 45.
<br />a. Is there a business (such as a store or barber
<br />shop) or a medical office on this property?
<br />Yes
<br />No
<br />b. How many aces is this house or mobile
<br />home on?
<br />0 Less than 1 acre -~ Skip to 45
<br />Q 1 to 9.9 acres
<br />Q 10 or more acres
<br />c In 1999, what were Lhe actual sales of all
<br />agricultural products. from this property?
<br />~;_ t
<br />Q None ;~\~:; ~ $2,500 to $4,999
<br />$1 to $999 :-~.'•~;•., ~ $5,000 to $9,999
<br />Q $1,000 ta$2,459 ~ ~ $10,000 or more
<br />., t~"
<br />What are the-annual costs of utilities and fuels for
<br />this house, apartment, or mobile home? !f you have
<br />lived tiera.i~ss than 1 year, estimate the annual cost.
<br />,; ~..
<br />.,
<br />a., Electricity
<br />..~; ,:
<br />.~ -annual cost -Dollars
<br />. _ .,
<br />OR
<br />~ Included in rent or in condominium fee
<br />No charge or electricity not used
<br />b. Gas
<br />Annual cost -Dollars
<br />..
<br />OR
<br />Q Included in rent or in condominium fee
<br />~ No charge or gas not used
<br />c Water and sewer
<br />Annual cost -Dollars
<br />~ i}
<br />OR
<br />Included in rent or in condominium fee
<br />0 No charge
<br />d. Oil, coal, kerosene, wood, etc.
<br />Annual cost -Dollars
<br />S ~~
<br />OR
<br />~ Included in rent or in condominium fee
<br />~ No charge or these fuels not used
<br />Form G619
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