RECORD OF BARANGAY INHABITANTS BY HOUSEHOLD

HOUSEHOLD ADDRESS: __________, _________________________, Purok _____, Barangay WASHINGTON, Catarman, Northern Samar, Region VIII
(House No.) (Street Name/Sitio) Survey for 2nd Semester of 2022
NAME Relationship SEX Date of Birth Place of Birth Educ.
Registere
Civil Registered
LN LAST FIRST MIDDLE EXT Age d Occupation
To HH (m/f) (mm/dd/yyyy) (City/Municipal,Province) Attain. Status Voter?
To LCRO?
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18

Relationship to HH Head: Civil Status: Registered to LCRO Educational Attainment: Prepared by: Certified correct:
1. HH Head 8. Niece/Nephew 1. Single 1 – Yes 1. Elem. Level
2. Spouse 9. Cousin 2. Legally Married 2 – No 2. Elem. Graduate
3. Son/Daughter 10. Step Son/Daughter 3. Live-in/Common Law 3 – Don’t know 3. High School Level
4. Brother/Daughter 11. Other Relative 4. Widow/Widower Registered Voter: 4. H.S. Graduate Kgd. _________________________ ____________________________
5. Son/Daughter-in-law 12. Boarder 1 – Yes 5. College Level (Interviewer’s Signature over Printed Name) (Household Head/Member 18 y/o above)
6. Grandchild 13. Domestic Helper 2 – No 6. College Graduate
7. Father/mother 3 – Don’t know 7. Vocational Course
Date Surveyed: JUNE 30, 2022