------+------+--------------+------------------------------------ | | Number[A] of| Amount of Rent paid per week Name |Postal|rooms occupied| for the rooms of |No. of|by each family|-----------+------------+----------- Street|house.|selected. |July, 1914.|March, 1922.|June, 1922. ------+------+--------------+-----+-----+-----+------+-----+----- | | | s. | d. | s. | d. | s. | d. | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | ------+------+--------------+-----+-----+-----+------+-----+----- [A: The numbers required are to represent different types of wage-earning class accommodation and, therefore, families should be selected occupying different numbers of rooms so as to properly represent local conditions.] _Date_ __________ 1922. _Signature_ ______________________ =Form B 6.=--Page 1. HOUSEHOLD BUDGET. 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:--