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Date: ___________________ (MM/DD) Date: ___________________ (MM/DD)

Total No. of BSN: _________ Total No. of BSN: _________


Total No. HUSN: __________ Total No. HUSN: __________
Total No. HSN: ___________ Total No. HSN: ___________
No. of Vacant Building: _____________ No. of Vacant Building: _____________
No. of Vacant Housing Unit: _________ No. of Vacant Housing Unit: _________
FORMS USED FORMS USED
No. of CPH 2: ___________ No. of CPH 2: ___________
No. of CPH 3: ___________ No. of CPH 3: ___________
No. of CPH 4: ___________ No. of CPH 4: ___________

Date: ___________________ (MM/DD) Date: ___________________ (MM/DD)


Total No. of BSN: _________ Total No. of BSN: _________
Total No. HUSN: __________ Total No. HUSN: __________
Total No. HSN: ___________ Total No. HSN: ___________
No. of Vacant Building: _____________ No. of Vacant Building: _____________
No. of Vacant Housing Unit: _________ No. of Vacant Housing Unit: _________
FORMS USED FORMS USED
No. of CPH 2: ___________ No. of CPH 2: ___________
No. of CPH 3: ___________ No. of CPH 3: ___________
No. of CPH 4: ___________ No. of CPH 4: ___________

Date: ___________________ (MM/DD) Date: ___________________ (MM/DD)


Total No. of BSN: _________ Total No. of BSN: _________
Total No. HUSN: __________ Total No. HUSN: __________
Total No. HSN: ___________ Total No. HSN: ___________
No. of Vacant Building: _____________ No. of Vacant Building: _____________
No. of Vacant Housing Unit: _________ No. of Vacant Housing Unit: _________
FORMS USED FORMS USED
No. of CPH 2: ___________ No. of CPH 2: ___________
No. of CPH 3: ___________ No. of CPH 3: ___________
No. of CPH 4: ___________ No. of CPH 4: ___________
Date: ___________________ (MM/DD) Date: ___________________ (MM/DD)
Total No. of BSN: _________ Total No. of BSN: _________
Total No. HUSN: __________ Total No. HUSN: __________
Total No. HSN: ___________ Total No. HSN: ___________
No. of Vacant Building: _____________ No. of Vacant Building: _____________
No. of Vacant Housing Unit: _________ No. of Vacant Housing Unit: _________
FORMS USED FORMS USED
No. of CPH 2: ___________ No. of CPH 2: ___________
No. of CPH 3: ___________ No. of CPH 3: ___________
No. of CPH 4: ___________ No. of CPH 4: ___________
Date: ___________________ (MM/DD) Date: ___________________ (MM/DD)
Total No. of BSN: _________ Total No. of BSN: _________
Total No. HUSN: __________ Total No. HUSN: __________
Total No. HSN: ___________ Total No. HSN: ___________
No. of Vacant Building: _____________ No. of Vacant Building: _____________
No. of Vacant Housing Unit: _________ No. of Vacant Housing Unit: _________
FORMS USED FORMS USED
No. of CPH 2: ___________ No. of CPH 2: ___________
No. of CPH 3: ___________ No. of CPH 3: ___________
No. of CPH 4: ___________ No. of CPH 4: ___________

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