HOUSEHOLD RECORD OF BARANGAY INHABITANTS

Business/House No. _________________________________

Lightning System
Water System:
Place of Origin/Ethnic Origin:__________________________
( ) Electricity
( ) Kerosene
( ) Solar
( ) Others: _____ ( )Spring
( ) Deep Well
( ) BWD
( ) water deliveries
Dialect: ___________________________________________
Source of information:
Toilet Facilities:
Housing Status:
( )TV
( )Radio
( )Newspaper
( )Internet
( )Others:____
( )Open Pit
( )Flush
( )
Others: _________________
Type of House: ( ) Concrete
( ) Semi-concrete
( ) wood/bamboo
Communication 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: _________________________________

NAME
FAMILY NAME

FIRST NAME

M.I.

S
E
X

C
S

Birth
Date

A
G
E

Place of Birth

Years
Stay
ed
In
the
Brgy.

Relations
hip to
Family
Head

Reg.
Vote
r
(Yes
)
(No)

Occupatio
n

Religion

Highest
Educational
Attainment