Personal Information:

is now years old.

status is

occupation is

wages are per year.

lives in Parish.

address is

lives in the

is paying per year in rent.

Family Information:

is

Economic Information:

is currently spending money according to
the

During the years spent two year income of
in the following manner:

of the money spent during these years was for rent.

of the money spent during these years was for
food, fuel, and other expenses.

.