PARTICULARS for all persons in a household at _________ Co
__________ during the seven days ended ___ June, 1922.
(NOTE.--Particulars for _each_ person should be given, one line
being devoted to _each_).
-----------------------+----------+----+-----------+---------
Description | | | |Earnings
(_e.g._, husband, wife,| Sex | | | for
father, son, niece, | (M) Male |Age.|Occupation.|the seven
servant, lodger, &c.).|(F) Female| | [1] | days.[2]
-----------------------+----------+----+-----------+---------
| | | | s. d.
(1) | | | |
(2) | | | |
(3) | | | |
(4) | | | |
(5) | | | |
(6) | | | |
(7) | | | |
(8) | | | |
(9) | | | |
(10) | | | |
-----------------------+----------+----+-----------+---------
[1. _e.g._, "Carpenter," "Dock |Total earnings(A)|
labourer," "domestic duties," "at| |
school," &c.] |Other receipts[E]|
[2. If there is a servant, her |-----------------|---------
wages should not be included here]Total income (B) |
(E) Receipts of old age or other |-----------------+---------
pensions should be included here and not in the column for
"earnings" above. Please state on the following lines
particulars of pensions or other receipts:--
---------------------------+----------------------------------
Observations with regard to| SUMMARY.
particulars on this page. |----------------------------------
| Number of Persons
| No.
|Who earned cash (A) ________
|Who did not earn cash (A) ________
|Total number of persons
| in the household ________
|----------------------------------
| s. d.
|Total _income_ (B)
| for the seven days ________
|----------------------------------
| Number of Persons
| No.
|Under 4 years ________
|4 years to 13 (inclusive) ________
|14 years and over ________
| --------
|Total number of persons
| in the household ________
=Form B 6.=--Page 2.
QUANTITIES AND COSTS OF ARTICLES CONSUMED DURING THE SEVEN DAYS ___
JUNE, TO ___ JUNE, 1922.
--------------------------+------+----+--------------------------+----+----
| Qty. |s.d.| |Qty.|s.d.
FOOD. | | | FUEL AND LIGHT. | |
(1) Beef | lb. | |(29) Coal |cwt.|
(2) Mutton | lb. | |(30) Turf |cwt.|
(3) Fresh pork | lb. | |(31) Firewood | |
(4) Sausages, black | lb. | |(32) Gas | |
puddings, &c. | | |(33) Electricity | |
(5) Bacon, pigs' heads, | lb. | |(34) Candles |lb. |
&c. | | |(35) Paraffin Oil |pts.|
--------------------------+------+----|(36) Other Fuel and Light |[3] |
| | |--------------------------+----+----
(6) Total Meat[4] | [3] |[4] |(37) Total Fuel & Light(E)|[3] |
(7) Fresh Fish | [3] | |--------------------------+----+----
(8) Cured or Tinned Fish | [3] | | | |
(9) Butter | lb. | | HOUSEHOLD REQUISITES. | |
(10) Cheese | lb. | |(38) Soap | |
(11) Margarine | lb. | |(39) Starch, blue, |[3] |
(12) Lard | lb. | | polishes, &c. | |
(13) Fresh Milk | pts. | |(40) Crockery, hardware, |[3] |
(14) Condensed Milk | lb. | | &c. | |
(15) Eggs | doz. | |(41) Other household |[3] |
(16) Bread | 2 lb.| | requisites. | |
|loaves| |(42) Total Household |[3] |
(17) Flour | lb. | | Requisites (F). | |
(18) Oatmeal, &c. | lb. | |--------------------------+----+----
(19) Rice, Sago, &c. | lb. | | | |
(20) Potatoes | lb. | | SUNDRIES. | |
(21) Other Vegetables | [3] | |(43) Pipe tobacco |oz. |
(22) Tea | lb. | |(44) Cigarettes |oz. |
(23) Sugar | lb. | |(45) Medicines, Ointments,|[3] |
(24) Jam | lb. | | Ointments, &c. | |
(25) Other food | [3] | |(46) Newspapers, &c. |[3] |
(26) Meals eaten at shops,| [3] | |(47) Train and tram fares,|[3] |
&c. | | | &c. | |
--------------------------+------+----|(48) Insurances |[3] |
(27) Total Food (C) | [3] |[4] |(49) | |
--------------------------+------+----|(50) | |
|(51) | |
(28) Clothes boots and | [3] | |--------------------------+----+
shoes (D) | | |(52) Total Sundries (G) |[3] |
--------------------------+------+----+--------------------------+----+
[3: Cost only is required.]
[4: When totting be careful not to add in Meat twice over.]
NOTE.--Food purchased for poultry, pigs, &c.; materials for making up
garments for _sale_; implements for producing goods _for sale_, &c.,
should not be included above.
_(H) RENTS (Including rates)._--What is the weekly rent (including rates)
of the house or rooms occupied by the household? ___ shillings and ___ pence.
Does the family own the house? ________ (yes or no). If the answer is "yes,"
insert the equivalent rent and rates.