+----------------------------+-------+--------------------------------+
| Interagency Report Control |       |                                |
| No. 1168-DOS-AN            |       |                                |
|                            |       |                                |
| **UNITED STATES DEPARTMENT |       |                                |
| OF STATE**                 |       |                                |
|                            |       |                                |
| Retail Price Schedule      |       |                                |
+----------------------------+-------+--------------------------------+
|                            | Post  |                                |
+----------------------------+-------+--------------------------------+
|                            | U.S.  |                                |
|                            | A     |                                |
|                            | gency |                                |
+----------------------------+-------+--------------------------------+
|                            | Date  |                                |
|                            | of    |                                |
|                            | S     |                                |
|                            | urvey |                                |
|                            | (Date |                                |
|                            | most  |                                |
|                            | data  |                                |
|                            | are   |                                |
|                            | colle |                                |
|                            | cted) |                                |
+----------------------------+-------+--------------------------------+
| [INSTRUCTIONS]{.underline} |       |                                |
|                            |       |                                |
| a\) BEFORE BEGINNING THIS  |       |                                |
| REPORT, REVIEW THE         |       |                                |
| INSTRUCTIONS IN THE SURVEY |       |                                |
| HANDBOOK PORTION (SECTION  |       |                                |
| 950) OF THE DEPARTMENT OF  |       |                                |
| STATE STANDARDIZED         |       |                                |
| REGULATIONS (DSSR).        |       |                                |
| REPORTS PREPARED FOR       |       |                                |
| UNIFORMED SERVICE MEMBERS  |       |                                |
| MUST FOLLOW PROCEDURES     |       |                                |
| PROVIDED IN APPENDIX M OF  |       |                                |
| THE JOINT FEDERAL TRAVEL   |       |                                |
| REGULATIONS                |       |                                |
|                            |       |                                |
| \(b\) If there has been a  |       |                                |
| previous survey, it must   |       |                                |
| be used as a guide in      |       |                                |
| preparing this report.     |       |                                |
|                            |       |                                |
| \(c\) Report prices in     |       |                                |
| currency used for actual   |       |                                |
| purchases by Americans.    |       |                                |
| Explain any use of         |       |                                |
| non-local currencies in    |       |                                |
| local retail outlets.      |       |                                |
|                            |       |                                |
| \(d\) Explain on each page |       |                                |
| of the report the          |       |                                |
| availability of any        |       |                                |
| \"cash\" or other special  |       |                                |
| discounts.                 |       |                                |
|                            |       |                                |
| \(e\) Use the space        |       |                                |
| provided to describe       |       |                                |
| brand, quality, origin, or |       |                                |
| other pertinent details    |       |                                |
| about the item.            |       |                                |
|                            |       |                                |
| \(f\) Use substitute       |       |                                |
| retail outlets for items   |       |                                |
| not available in the       |       |                                |
| regular survey outlet.     |       |                                |
|                            |       |                                |
| \(g\) Report on each page  |       |                                |
| of the schedule any retail |       |                                |
| sales taxes not included   |       |                                |
| in the prices listed.      |       |                                |
| (Specify the tax rate on   |       |                                |
| each type of goods or      |       |                                |
| services.)                 |       |                                |
|                            |       |                                |
| \(h\) List prevailing      |       |                                |
| sales tax percentages and  |       |                                |
| currency exchange rates    |       |                                |
| available to Federal       |       |                                |
| Government personnel       |       |                                |
| (civilian and military):   |       |                                |
|                            |       |                                |
| Survey Tax Rate:           |       |                                |
|                            |       |                                |
| Survey Exchange Rate:      |       |                                |
|                            |       |                                |
| Source of Exchange Rate    |       |                                |
| (e.g., bank, USG facility, |       |                                |
| etc.):                     |       |                                |
|                            |       |                                |
| Date of Exchange Rate      |       |                                |
| Information (effective the |       |                                |
| date of the survey):       |       |                                |
+----------------------------+-------+--------------------------------+
| [Survey                    |       | OFFICER WITH OVERALL           |
| R                          |       | RESPONSIBILITY                 |
| esponsibility]{.underline} |       |                                |
|                            |       | FOR THIS SURVEY                |
| Indicate below the signed  |       |                                |
| concurrence of             |       | I hereby certify that the      |
| representatives of all     |       | retail outlets selected for    |
| U.S. Government Agencies   |       | this survey are based on       |
| at post affected by this   |       | current employee living        |
| report (including military |       | pattern survey information and |
| component):                |       | that the report was prepared   |
|                            |       | in accordance with             |
| [Agency]{.underline}       |       | instructions in the survey     |
| [Names of                  |       | handbook, DSSR Section 950.    |
| Re                         |       |                                |
| presentatives]{.underline} |       | I also certify that the last   |
|                            |       | living pattern survey was      |
| List the individuals       |       | completed in full compliance   |
| responsible for price      |       | with the instructions in the   |
| collection:                |       | Standardized Regulations.      |
|                            |       |                                |
| [Agency]{.underline}       |       |                                |
| [Names of Price            |       |                                |
| Collectors]{.underline}    |       |                                |
+----------------------------+-------+--------------------------------+
|                            |       | Signature of Certifying        |
|                            |       | Official                       |
+----------------------------+-------+--------------------------------+
|                            |       | Name (Printed or Typed)        |
+----------------------------+-------+--------------------------------+
|                            |       | Title                          |
|                            |       |                                |
|                            |       | Date Survey Began:             |
|                            |       |                                |
|                            |       | Date Completed:                |
+----------------------------+-------+--------------------------------+

Form DSP-23Y Revised 10/98 RETAIL SCHEDULE (FORM DSP-23Y)

  -----------------------------------------------------------------------
  **CATEGORY: MEAT AND DAIRY PRODUCTS**

  CATEGORY TAX RATE:
  -----------------------------------------------------------------------

+-----------------------+--------+--------+--------+------------------+
| **SUBCATEGORY: BEEF** | QU     | UNIT   | PRICE  | DESCRIPTION      |
|                       | ANTITY |        |        |                  |
| TAX INCLUDED IN       |        | (lb    |        |                  |
| REPORTED PRICE?       |        | ./kg.) |        |                  |
|                       |        |        |        |                  |
|  YES  NO  N/A      |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| **MOST FREQUENTLY     |        |        |        |                  |
| USED OUTLET**         |        |        |        |                  |
|                       |        |        |        |                  |
| NAME(S):              |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 1\. Beef Steak        |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 2\. Beef Roast        |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 3\. Beef Hamburger    |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| **Comments:**         |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| **SECOND MOST USED    |        |        |        |                  |
| OUTLET**              |        |        |        |                  |
|                       |        |        |        |                  |
| NAME(S):              |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 1\. Beef Steak        |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 2\. Beef Roast        |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 3\. Beef Hamburger    |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| **Comments:**         |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+

+-----------------------+--------+--------+--------+------------------+
| **SUBCATEGORY: PORK** | QU     | UNIT   | PRICE  | DESCRIPTION      |
|                       | ANTITY |        |        |                  |
| TAX INCLUDED IN       |        | (lb    |        |                  |
| REPORTED PRICE?       |        | ./kg.) |        |                  |
|                       |        |        |        |                  |
|  YES  NO  N/A      |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| **MOST FREQUENTLY     |        |        |        |                  |
| USED OUTLET**         |        |        |        |                  |
|                       |        |        |        |                  |
| NAME(S):              |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 1\. Pork Chops        |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 2\. Loin Roast        |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| **Comments:**         |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| **SECOND MOST USED    |        |        |        |                  |
| OUTLET**              |        |        |        |                  |
|                       |        |        |        |                  |
| NAME(S):              |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 1\. Pork Chops        |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 2\. Loin Roast        |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| **Comments:**         |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+

MEAT AND DAIRY PRODUCTS

  -----------------------------------------------------------------------
  **CATEGORY: MEAT AND DAIRY PRODUCTS (CONT.)**

  CATEGORY TAX RATE:
  -----------------------------------------------------------------------

+-----------------------+--------+--------+--------+------------------+
| **SUBCATEGORY: LAMB** | QU     | UNIT   | PRICE  | DESCRIPTION      |
|                       | ANTITY |        |        |                  |
| TAX INCLUDED IN       |        | (lb    |        |                  |
| REPORTED PRICE?       |        | ./kg.) |        |                  |
|                       |        |        |        |                  |
|  YES  NO  N/A      |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| **MOST FREQUENTLY     |        |        |        |                  |
| USED OUTLET**         |        |        |        |                  |
|                       |        |        |        |                  |
| NAME(S):              |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 1\. Lamb Chops        |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 2\. Lamb, Leg of      |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| **Comments:**         |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| **SECOND MOST USED    |        |        |        |                  |
| OUTLET**              |        |        |        |                  |
|                       |        |        |        |                  |
| NAME(S):              |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 1\. Lamb Chops        |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 2\. Lamb, Leg of      |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| **Comments:**         |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+

+---------------+------+--------+--------+--------+------------------+
| *             |      | QU     | UNIT   | PRICE  | DESCRIPTION      |
| *SUBCATEGORY: |      | ANTITY |        |        |                  |
| SEAFOOD**     |      |        | (lb    |        |                  |
|               |      |        | ./kg.) |        |                  |
| TAX INCLUDED  |      |        |        |        |                  |
| IN REPORTED   |      |        |        |        |                  |
| PRICE?        |      |        |        |        |                  |
|               |      |        |        |        |                  |
|  YES  NO   |      |        |        |        |                  |
| N/A           |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **MOST        |      |        |        |        |                  |
| FREQUENTLY    |      |        |        |        |                  |
| USED OUTLET** |      |        |        |        |                  |
|               |      |        |        |        |                  |
| NAME(S):      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 1\. Fish,     | Typ  |        |        |        |                  |
| Fresh         | ical |        |        |        |                  |
|               |      |        |        |        |                  |
| (uncooked     |      |        |        |        |                  |
| filet;        |      |        |        |        |                  |
| specify type) |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 2\. Fish,     | Typ  |        |        |        |                  |
| Canned        | ical |        |        |        |                  |
|               |      |        |        |        |                  |
| (specify      |      |        |        |        |                  |
| type)         |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **Comments:** |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **SECOND MOST |      |        |        |        |                  |
| USED OUTLET** |      |        |        |        |                  |
|               |      |        |        |        |                  |
| NAME(S):      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 1\. Fish,     | Typ  |        |        |        |                  |
| Fresh         | ical |        |        |        |                  |
|               |      |        |        |        |                  |
| (uncooked     |      |        |        |        |                  |
| filet;        |      |        |        |        |                  |
| specify type) |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 2\. Fish,     | Typ  |        |        |        |                  |
| Canned        | ical |        |        |        |                  |
|               |      |        |        |        |                  |
| (specify      |      |        |        |        |                  |
| type)         |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **Comments:** |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+

MEAT AND DAIRY PRODUCTS

  -----------------------------------------------------------------------
  **CATEGORY: MEAT AND DAIRY PRODUCTS (CONT.)**

  CATEGORY TAX RATE:
  -----------------------------------------------------------------------

+---------------+------+--------+--------+--------+------------------+
| *             |      | QU     | UNIT   | PRICE  | DESCRIPTION      |
| *SUBCATEGORY: |      | ANTITY |        |        |                  |
| POULTRY**     |      |        | (lb    |        |                  |
|               |      |        | ./kg.) |        |                  |
| TAX INCLUDED  |      |        |        |        |                  |
| IN REPORTED   |      |        |        |        |                  |
| PRICE?        |      |        |        |        |                  |
|               |      |        |        |        |                  |
|  YES  NO   |      |        |        |        |                  |
| N/A           |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **MOST        |      |        |        |        |                  |
| FREQUENTLY    |      |        |        |        |                  |
| USED OUTLET** |      |        |        |        |                  |
|               |      |        |        |        |                  |
| NAME(S):      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 1\. Chicken,  | Typ  |        |        |        |                  |
| Whole         | ical |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **Comments:** |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **SECOND MOST |      |        |        |        |                  |
| USED OUTLET** |      |        |        |        |                  |
|               |      |        |        |        |                  |
| NAME(S):      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 1\. Chicken,  | Typ  |        |        |        |                  |
| Whole         | ical |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **Comments:** |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+

+---------------+------+--------+--------+--------+------------------+
| *             |      | QU     | UNIT   | PRICE  | BRAND AND        |
| *SUBCATEGORY: |      | ANTITY |        |        | DESCRIPTION      |
| DAIRY         |      |        |        |        |                  |
| PRODUCTS**    |      |        |        |        |                  |
|               |      |        |        |        |                  |
| TAX INCLUDED  |      |        |        |        |                  |
| IN REPORTED   |      |        |        |        |                  |
| PRICE?        |      |        |        |        |                  |
|               |      |        |        |        |                  |
|  YES  NO   |      |        |        |        |                  |
| N/A           |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **MOST        |      |        |        |        |                  |
| FREQUENTLY    |      |        |        |        |                  |
| USED OUTLET** |      |        |        |        |                  |
|               |      |        |        |        |                  |
| NAME(S):      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 1\. Eggs (per | Typ  |        |        |        |                  |
| dozen)        | ical |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 2\. Ice Cream | Typ  |        |        |        |                  |
| (liter/quart) | ical |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 3\. Margarine | Typ  |        |        |        |                  |
|               | ical |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 4\. Cheese    | Typ  |        |        |        |                  |
|               | ical |        |        |        |                  |
| (natural,     |      |        |        |        |                  |
| firm to hard) |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **Comments:** |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+

MEAT AND DAIRY PRODUCTS

  -----------------------------------------------------------------------
  **CATEGORY: MEAT AND DAIRY PRODUCTS (CONT.)**

  CATEGORY TAX RATE:
  -----------------------------------------------------------------------

+---------------+------+--------+--------+--------+------------------+
| *             |      |        |        |        |                  |
| *SUBCATEGORY: |      |        |        |        |                  |
| DAIRY         |      |        |        |        |                  |
| PRODUCTS      |      |        |        |        |                  |
| (Cont.)**     |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **SECOND MOST |      |        |        |        |                  |
| USED OUTLET** |      |        |        |        |                  |
|               |      |        |        |        |                  |
| NAME(S):      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 1\. Eggs (per | Typ  |        |        |        |                  |
| dozen)        | ical |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 2\. Ice Cream | Typ  |        |        |        |                  |
| (liter/quart) | ical |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 3\. Margarine | Typ  |        |        |        |                  |
|               | ical |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 4\. Cheese    | Typ  |        |        |        |                  |
|               | ical |        |        |        |                  |
| (natural,     |      |        |        |        |                  |
| firm to hard) |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **Comments:** |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+

  -----------------------------------------------------------------------
  **CATEGORY: GROCERIES**

  CATEGORY TAX RATE:
  -----------------------------------------------------------------------

+---------------+------+--------+--------+--------+------------------+
| *             |      | QU     | UNIT   | PRICE  | BRAND AND        |
| *SUBCATEGORY: |      | ANTITY |        |        | DESCRIPTION      |
| MILK**        |      |        |        |        |                  |
|               |      |        |        |        |                  |
| TAX INCLUDED  |      |        |        |        |                  |
| IN REPORTED   |      |        |        |        |                  |
| PRICE?        |      |        |        |        |                  |
|               |      |        |        |        |                  |
|  YES  NO   |      |        |        |        |                  |
| N/A           |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **MOST        |      |        |        |        |                  |
| FREQUENTLY    |      |        |        |        |                  |
| USED OUTLET** |      |        |        |        |                  |
|               |      |        |        |        |                  |
| NAME(S):      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 1\. Milk,     | Typ  |        |        |        |                  |
| Fresh         | ical |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 2\. Milk,     | Typ  |        |        |        |                  |
| Dried         | ical |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **Comments:** |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **SECOND MOST |      |        |        |        |                  |
| USED OUTLET** |      |        |        |        |                  |
|               |      |        |        |        |                  |
| NAME(S):      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 1\. Milk,     | Typ  |        |        |        |                  |
| Fresh         | ical |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+

MEAT & DAIRY PRODUCTS/GROCERIES

  -----------------------------------------------------------------------
  **CATEGORY: GROCERIES (CONT.)**

  CATEGORY TAX RATE:
  -----------------------------------------------------------------------

  ---------------- ------------ --------- --------- --------- ------------------
  **SUBCATEGORY:                                              
  MILK (Cont.)**                                              

  2\. Milk, Dried  Typical                                    

                   Substitute                                 

                   Economy                                    

  **Comments:**                                               
  ---------------- ------------ --------- --------- --------- ------------------

+---------------+------+--------+--------+--------+------------------+
| *             |      | QU     | UNIT   | PRICE  | BRAND AND        |
| *SUBCATEGORY: |      | ANTITY |        |        | DESCRIPTION      |
| BREAD,        |      |        | (lb    |        |                  |
| FLOUR**       |      |        | ./kg.) |        |                  |
|               |      |        |        |        |                  |
| TAX INCLUDED  |      |        |        |        |                  |
| IN REPORTED   |      |        |        |        |                  |
| PRICE?        |      |        |        |        |                  |
|               |      |        |        |        |                  |
|  YES  NO   |      |        |        |        |                  |
| N/A           |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **MOST        |      |        |        |        |                  |
| FREQUENTLY    |      |        |        |        |                  |
| USED OUTLET** |      |        |        |        |                  |
|               |      |        |        |        |                  |
| NAME(S):      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 1\. Bread,    | Typ  |        |        |        |                  |
| White         | ical |        |        |        |                  |
| (sliced)      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 2\. Flour     | Typ  |        |        |        |                  |
|               | ical |        |        |        |                  |
| (Bread or     |      |        |        |        |                  |
| General       |      |        |        |        |                  |
| Purpose)      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **Comments:** |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **SECOND MOST |      |        |        |        |                  |
| USED OUTLET** |      |        |        |        |                  |
|               |      |        |        |        |                  |
| NAME(S):      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 1\. Bread,    | Typ  |        |        |        |                  |
| White         | ical |        |        |        |                  |
| (sliced)      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 2\. Flour     | Typ  |        |        |        |                  |
|               | ical |        |        |        |                  |
| (Bread or     |      |        |        |        |                  |
| General       |      |        |        |        |                  |
| Purpose)      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **Comments:** |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+

GROCERIES

  -----------------------------------------------------------------------
  **CATEGORY: GROCERIES (CONT.)**

  CATEGORY TAX RATE:
  -----------------------------------------------------------------------

+---------------+------+--------+--------+--------+------------------+
| *             |      | QU     | UNIT   | PRICE  | BRAND AND        |
| *SUBCATEGORY: |      | ANTITY |        |        | DESCRIPTION      |
| CEREAL**      |      |        | (oz    |        |                  |
|               |      |        | ./gr.) |        |                  |
| TAX INCLUDED  |      |        |        |        |                  |
| IN REPORTED   |      |        |        |        |                  |
| PRICE?        |      |        |        |        |                  |
|               |      |        |        |        |                  |
|  YES  NO   |      |        |        |        |                  |
| N/A           |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **MOST        |      |        |        |        |                  |
| FREQUENTLY    |      |        |        |        |                  |
| USED OUTLET** |      |        |        |        |                  |
|               |      |        |        |        |                  |
| NAME(S):      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| Cereal,       | Typ  |        |        |        |                  |
| Breakfast     | ical |        |        |        |                  |
|               |      |        |        |        |                  |
| (             |      |        |        |        |                  |
| Ready-to-eat) |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **Comments:** |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **SECOND MOST |      |        |        |        |                  |
| USED OUTLET** |      |        |        |        |                  |
|               |      |        |        |        |                  |
| NAME(S):      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| Cereal,       | Typ  |        |        |        |                  |
| Breakfast     | ical |        |        |        |                  |
|               |      |        |        |        |                  |
| (             |      |        |        |        |                  |
| Ready-to-eat) |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **Comments:** |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+

+---------------+------+--------+--------+--------+------------------+
| *             |      | QU     | UNIT   | PRICE  | BRAND AND        |
| *SUBCATEGORY: |      | ANTITY |        |        | DESCRIPTION      |
| RICE/PASTA**  |      |        | (oz    |        |                  |
|               |      |        | ./gr.) |        |                  |
| TAX INCLUDED  |      |        |        |        |                  |
| IN REPORTED   |      |        |        |        |                  |
| PRICE?        |      |        |        |        |                  |
|               |      |        |        |        |                  |
|  YES  NO   |      |        |        |        |                  |
| N/A           |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **MOST        |      |        |        |        |                  |
| FREQUENTLY    |      |        |        |        |                  |
| USED OUTLET** |      |        |        |        |                  |
|               |      |        |        |        |                  |
| NAME(S):      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 1\. Rice,     | Typ  |        |        |        |                  |
| Regular       | ical |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 2\. Pasta     | Typ  |        |        |        |                  |
| (uncooked)    | ical |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **Comments:** |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **SECOND MOST |      |        |        |        |                  |
| USED OUTLET** |      |        |        |        |                  |
|               |      |        |        |        |                  |
| NAME(S):      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 1\. Rice,     | Typ  |        |        |        |                  |
| Regular       | ical |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+

GROCERIES

  -----------------------------------------------------------------------
  **CATEGORY: GROCERIES (CONT.)**

  CATEGORY TAX RATE:
  -----------------------------------------------------------------------

  ---------------- ------------ --------- --------- --------- ------------------
  **SUBCATEGORY:                                              
  RICE/PASTA                                                  
  (Cont.)**                                                   

  2\. Pasta        Typical                                    
  (uncooked)                                                  

                   Substitute                                 

                   Economy                                    

  **Comments:**                                               
  ---------------- ------------ --------- --------- --------- ------------------

+---------------+------+--------+--------+--------+------------------+
| *             |      | QU     | UNIT   | PRICE  | BRAND AND        |
| *SUBCATEGORY: |      | ANTITY |        |        | DESCRIPTION      |
| TEA/COFFEE**  |      |        | (oz    |        |                  |
|               |      |        | ./gr.) |        |                  |
| TAX INCLUDED  |      |        |        |        |                  |
| IN REPORTED   |      |        |        |        |                  |
| PRICE?        |      |        |        |        |                  |
|               |      |        |        |        |                  |
|  YES  NO   |      |        |        |        |                  |
| N/A           |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **MOST        |      |        |        |        |                  |
| FREQUENTLY    |      |        |        |        |                  |
| USED OUTLET** |      |        |        |        |                  |
|               |      |        |        |        |                  |
| NAME(S):      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 1\. Tea, Bags | Typ  |        |        |        |                  |
| (specify \#   | ical |        |        |        |                  |
|               |      |        |        |        |                  |
| bags)         |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 2\. Coffee,   | Typ  |        |        |        |                  |
| Ground        | ical |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 3\. Coffee,   | Typ  |        |        |        |                  |
| Instant       | ical |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **Comments:** |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **SECOND MOST |      |        |        |        |                  |
| USED OUTLET** |      |        |        |        |                  |
|               |      |        |        |        |                  |
| NAME(S):      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 1\. Tea, Bags | Typ  |        |        |        |                  |
| (specify \#   | ical |        |        |        |                  |
|               |      |        |        |        |                  |
| bags)         |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 2\. Coffee,   | Typ  |        |        |        |                  |
| Ground        | ical |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 3\. Coffee,   | Typ  |        |        |        |                  |
| Instant       | ical |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **Comments:** |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+

GROCERIES

  -----------------------------------------------------------------------
  **CATEGORY: GROCERIES (CONT.)**

  CATEGORY TAX RATE:
  -----------------------------------------------------------------------

+---------------+------+--------+--------+--------+------------------+
| *             |      | QU     | UNIT   | PRICE  | BRAND AND        |
| *SUBCATEGORY: |      | ANTITY |        |        | DESCRIPTION      |
| SOFT          |      |        | (fluid |        |                  |
| DRINKS/**     |      |        | oz     |        |                  |
|               |      |        | ./ml.) |        |                  |
| **BOTTLED     |      |        |        |        |                  |
| WATER**       |      |        |        |        |                  |
|               |      |        |        |        |                  |
| TAX INCLUDED  |      |        |        |        |                  |
| IN REPORTED   |      |        |        |        |                  |
| PRICE?        |      |        |        |        |                  |
|               |      |        |        |        |                  |
|  YES  NO   |      |        |        |        |                  |
| N/A           |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **MOST        |      |        |        |        |                  |
| FREQUENTLY    |      |        |        |        |                  |
| USED OUTLET** |      |        |        |        |                  |
|               |      |        |        |        |                  |
| NAME(S):      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 1\. Soft      | Typ  |        |        |        |                  |
| Drink,        | ical |        |        |        |                  |
| Carbonated\*  |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 2\. Locally   | Typ  |        |        |        |                  |
| Bottled       | ical |        |        |        |                  |
|               |      |        |        |        |                  |
| Drinking      |      |        |        |        |                  |
| Water\*       |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **Comments:   |      |        |        |        |                  |
| \*Items 1 and |      |        |        |        |                  |
| 2 - Report    |      |        |        |        |                  |
| any bottle    |      |        |        |        |                  |
| deposits      |      |        |        |        |                  |
| separately    |      |        |        |        |                  |
| under         |      |        |        |        |                  |
| Description   |      |        |        |        |                  |
| column.**     |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **SECOND MOST |      |        |        |        |                  |
| USED OUTLET** |      |        |        |        |                  |
|               |      |        |        |        |                  |
| NAME(S):      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 1\. Soft      | Typ  |        |        |        |                  |
| Drink,        | ical |        |        |        |                  |
| Carbonated\*  |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 2\. Locally   | Typ  |        |        |        |                  |
| Bottled       | ical |        |        |        |                  |
|               |      |        |        |        |                  |
| Drinking      |      |        |        |        |                  |
| Water\*       |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **Comments:   |      |        |        |        |                  |
| \*Items 1 and |      |        |        |        |                  |
| 2 - Report    |      |        |        |        |                  |
| any bottle    |      |        |        |        |                  |
| deposits      |      |        |        |        |                  |
| separately    |      |        |        |        |                  |
| under         |      |        |        |        |                  |
| Description   |      |        |        |        |                  |
| column.**     |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+

GROCERIES

  -----------------------------------------------------------------------
  **CATEGORY: GROCERIES (CONT.)**

  CATEGORY TAX RATE:
  -----------------------------------------------------------------------

+---------------+------+--------+--------+--------+------------------+
| *             |      | QU     | UNIT   | PRICE  | BRAND AND        |
| *SUBCATEGORY: |      | ANTITY |        |        | DESCRIPTION      |
| CANDY/SUGAR** |      |        | (oz    |        |                  |
|               |      |        | ./gr.) |        |                  |
| TAX INCLUDED  |      |        |        |        |                  |
| IN REPORTED   |      |        |        |        |                  |
| PRICE?        |      |        |        |        |                  |
|               |      |        |        |        |                  |
|  YES  NO   |      |        |        |        |                  |
| N/A           |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **MOST        |      |        |        |        |                  |
| FREQUENTLY    |      |        |        |        |                  |
| USED OUTLET** |      |        |        |        |                  |
|               |      |        |        |        |                  |
| NAME(S):      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 1\. Candy,    | Typ  |        |        |        |                  |
| Chocolate Bar | ical |        |        |        |                  |
|               |      |        |        |        |                  |
| (Plain)       |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 2\. Sugar,    | Typ  |        |        |        |                  |
| Granulated    | ical |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **Comments:** |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **SECOND MOST |      |        |        |        |                  |
| USED OUTLET** |      |        |        |        |                  |
|               |      |        |        |        |                  |
| NAME(S):      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 1\. Candy,    | Typ  |        |        |        |                  |
| Chocolate Bar | ical |        |        |        |                  |
|               |      |        |        |        |                  |
| (Plain)       |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 2\. Sugar,    | Typ  |        |        |        |                  |
| Granulated    | ical |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **Comments:** |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+

GROCERIES

  -----------------------------------------------------------------------
  **CATEGORY: GROCERIES (CONT.)**

  CATEGORY TAX RATE:
  -----------------------------------------------------------------------

+---------------+------+--------+--------+--------+------------------+
| *             |      | QU     | UNIT   | PRICE  | BRAND AND        |
| *SUBCATEGORY: |      | ANTITY |        |        | DESCRIPTION      |
| BABY FOOD**   |      |        | (oz    |        |                  |
|               |      |        | ./gr.) |        |                  |
| TAX INCLUDED  |      |        |        |        |                  |
| IN REPORTED   |      |        |        |        |                  |
| PRICE?        |      |        |        |        |                  |
|               |      |        |        |        |                  |
|  YES  NO   |      |        |        |        |                  |
| N/A           |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **MOST        |      |        |        |        |                  |
| FREQUENTLY    |      |        |        |        |                  |
| USED OUTLET** |      |        |        |        |                  |
|               |      |        |        |        |                  |
| NAME(S):      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| Baby Food     | Typ  |        |        |        |                  |
| (exclude      | ical |        |        |        |                  |
| meat)         |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **Comments:** |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **SECOND MOST |      |        |        |        |                  |
| USED OUTLET** |      |        |        |        |                  |
|               |      |        |        |        |                  |
| NAME(S):      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| Baby Food     | Typ  |        |        |        |                  |
| (exclude      | ical |        |        |        |                  |
| meat)         |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **Comments:** |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+

+---------------+------+--------+--------+--------+------------------+
| *             |      | QU     | UNIT   | PRICE  | BRAND AND        |
| *SUBCATEGORY: |      | ANTITY |        |        | DESCRIPTION      |
| FATS, OTHER** |      |        | (fluid |        |                  |
|               |      |        | oz     |        |                  |
| TAX INCLUDED  |      |        | ./ml.) |        |                  |
| IN REPORTED   |      |        |        |        |                  |
| PRICE?        |      |        |        |        |                  |
|               |      |        |        |        |                  |
|  YES  NO   |      |        |        |        |                  |
| N/A           |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **MOST        |      |        |        |        |                  |
| FREQUENTLY    |      |        |        |        |                  |
| USED OUTLET** |      |        |        |        |                  |
|               |      |        |        |        |                  |
| NAME(S):      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| Fats, Other   | Typ  |        |        |        |                  |
| (cooking oil) | ical |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **Comments:** |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **SECOND MOST |      |        |        |        |                  |
| USED OUTLET** |      |        |        |        |                  |
|               |      |        |        |        |                  |
| NAME(S):      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| Fats, Other   | Typ  |        |        |        |                  |
| (cooking oil) | ical |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **Comments:** |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+

GROCERIES

  -----------------------------------------------------------------------
  **CATEGORY: TOBACCO/ALCOHOL**

  CATEGORY TAX RATE:
  -----------------------------------------------------------------------

+---------------+------+--------+--------+--------+------------------+
| *             |      | QU     | UNIT   | PRICE  | BRAND AND        |
| *SUBCATEGORY: |      | ANTITY |        |        | DESCRIPTION      |
| WINE, TABLE** |      |        | (fluid |        |                  |
|               |      |        | oz     |        |                  |
| TAX INCLUDED  |      |        | ./ml.) |        |                  |
| IN REPORTED   |      |        |        |        |                  |
| PRICE?        |      |        |        |        |                  |
|               |      |        |        |        |                  |
|  YES  NO   |      |        |        |        |                  |
| N/A           |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **MOST        |      |        |        |        |                  |
| FREQUENTLY    |      |        |        |        |                  |
| USED OUTLET** |      |        |        |        |                  |
|               |      |        |        |        |                  |
| NAME(S):      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| Wine, Table   | Typ  |        |        |        |                  |
| (1 bottle)    | ical |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **Comments:** |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **SECOND MOST |      |        |        |        |                  |
| USED OUTLET** |      |        |        |        |                  |
|               |      |        |        |        |                  |
| NAME(S):      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| Wine, Table   | Typ  |        |        |        |                  |
| (1 bottle)    | ical |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **Comments:** |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+

+---------------+------+--------+--------+--------+------------------+
| *             |      | QU     | UNIT   | PRICE  | BRAND AND        |
| *SUBCATEGORY: |      | ANTITY |        |        | DESCRIPTION      |
| WHISKEY**     |      |        | (fluid |        |                  |
|               |      |        | oz     |        |                  |
| TAX INCLUDED  |      |        | ./ml.) |        |                  |
| IN REPORTED   |      |        |        |        |                  |
| PRICE?        |      |        |        |        |                  |
|               |      |        |        |        |                  |
|  YES  NO   |      |        |        |        |                  |
| N/A           |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **MOST        |      |        |        |        |                  |
| FREQUENTLY    |      |        |        |        |                  |
| USED OUTLET** |      |        |        |        |                  |
|               |      |        |        |        |                  |
| NAME(S):      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| Whiskey       | Typ  |        |        |        |                  |
| (scotch, rye, | ical |        |        |        |                  |
| etc.)         |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **Comments:** |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **SECOND MOST |      |        |        |        |                  |
| USED OUTLET** |      |        |        |        |                  |
|               |      |        |        |        |                  |
| NAME(S):      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| Whiskey       | Typ  |        |        |        |                  |
| (scotch, rye, | ical |        |        |        |                  |
| etc.)         |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **Comments:** |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+

TOBACCO AND ALCOHOL

  -----------------------------------------------------------------------
  **CATEGORY: TOBACCO/ALCOHOL (CONT.)**

  CATEGORY TAX RATE:
  -----------------------------------------------------------------------

+---------------+------+--------+--------+--------+------------------+
| *             |      | QU     | UNIT   | PRICE  | BRAND AND        |
| *SUBCATEGORY: |      | ANTITY |        |        | DESCRIPTION      |
| BEER**        |      |        | (fluid |        |                  |
|               |      |        | oz     |        |                  |
| TAX INCLUDED  |      |        | ./ml.) |        |                  |
| IN REPORTED   |      |        |        |        |                  |
| PRICE?        |      |        |        |        |                  |
|               |      |        |        |        |                  |
|  YES  NO   |      |        |        |        |                  |
| N/A           |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **MOST        |      |        |        |        |                  |
| FREQUENTLY    |      |        |        |        |                  |
| USED OUTLET** |      |        |        |        |                  |
|               |      |        |        |        |                  |
| NAME(S):      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| Beer\*        | Typ  |        |        |        |                  |
|               | ical |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **Comments:   |      |        |        |        |                  |
| \*Report any  |      |        |        |        |                  |
| bottle        |      |        |        |        |                  |
| deposit       |      |        |        |        |                  |
| separately in |      |        |        |        |                  |
| Description   |      |        |        |        |                  |
| column.**     |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **SECOND MOST |      |        |        |        |                  |
| USED OUTLET** |      |        |        |        |                  |
|               |      |        |        |        |                  |
| NAME(S):      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| Beer\*        | Typ  |        |        |        |                  |
|               | ical |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **Comments:   |      |        |        |        |                  |
| \*Report any  |      |        |        |        |                  |
| bottle        |      |        |        |        |                  |
| deposit       |      |        |        |        |                  |
| separately in |      |        |        |        |                  |
| Description   |      |        |        |        |                  |
| column.**     |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+

+---------------+------+--------+--------+--------+------------------+
| *             |      | QU     | UNIT   | PRICE  | BRAND AND        |
| *SUBCATEGORY: |      | ANTITY |        |        | DESCRIPTION      |
| CIGARETTES**  |      |        | (C     |        |                  |
|               |      |        | arton) |        |                  |
| TAX INCLUDED  |      |        |        |        |                  |
| IN REPORTED   |      |        |        |        |                  |
| PRICE?        |      |        |        |        |                  |
|               |      |        |        |        |                  |
|  YES  NO   |      |        |        |        |                  |
| N/A           |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **MOST        |      |        |        |        |                  |
| FREQUENTLY    |      |        |        |        |                  |
| USED OUTLET** |      |        |        |        |                  |
|               |      |        |        |        |                  |
| NAME(S):      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| Cigarettes    | Typ  |        |        |        |                  |
| (carton of    | ical |        |        |        |                  |
| 200)          |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **Comments:** |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **SECOND MOST |      |        |        |        |                  |
| USED OUTLET** |      |        |        |        |                  |
|               |      |        |        |        |                  |
| NAME(S):      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| Cigarettes    | Typ  |        |        |        |                  |
| (carton of    | ical |        |        |        |                  |
| 200)          |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **Comments:** |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+

TOBACCO AND ALCOHOL

  -----------------------------------------------------------------------
  **CATEGORY: FRUITS/VEGETABLES**

  CATEGORY TAX RATE:
  -----------------------------------------------------------------------

+-----------------------+--------+--------+--------+------------------+
| **SUBCATEGORY: FRUIT, | QU     | UNIT   | PRICE  | BRAND AND        |
| FRESH**               | ANTITY |        |        | DESCRIPTION      |
|                       |        | (lb    |        |                  |
| TAX INCLUDED IN       |        | ./kg.) |        |                  |
| REPORTED PRICE?       |        |        |        |                  |
|                       |        |        |        |                  |
|  YES  NO  N/A      |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| **MOST FREQUENTLY     |        |        |        |                  |
| USED OUTLET**         |        |        |        |                  |
|                       |        |        |        |                  |
| NAME(S):              |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 1\. Oranges           |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 2\. Lemons            |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 3\. Apples            |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 4\. Bananas           |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 5\. Pineapples        |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| **Comments:**         |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| **SECOND MOST USED    |        |        |        |                  |
| OUTLET**              |        |        |        |                  |
|                       |        |        |        |                  |
| NAME(S):              |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 1\. Oranges           |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 2\. Lemons            |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 3\. Apples            |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 4\. Bananas           |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 5\. Pineapples        |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| **Comments:**         |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+

+-----------------------+--------+--------+--------+------------------+
| **SUBCATEGORY: JUICE, | QU     | UNIT   | PRICE  | BRAND AND        |
| CANNED**              | ANTITY |        |        | DESCRIPTION      |
|                       |        | (fluid |        |                  |
| TAX INCLUDED IN       |        | oz     |        |                  |
| REPORTED PRICE?       |        | ./ml.) |        |                  |
|                       |        |        |        |                  |
|  YES  NO  N/A      |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| **MOST FREQUENTLY     |        |        |        |                  |
| USED OUTLET**         |        |        |        |                  |
|                       |        |        |        |                  |
| NAME(S):              |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 1\. Apple Juice       |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 2\. Orange Juice      |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 3\. Tomato Juice      |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| **Comments:**         |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| **SECOND MOST USED    |        |        |        |                  |
| OUTLET**              |        |        |        |                  |
|                       |        |        |        |                  |
| NAME(S):              |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 1\. Apple Juice       |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 2\. Orange Juice      |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 3\. Tomato Juice      |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| **Comments:**         |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+

FRUITS/VEGETABLES

  -----------------------------------------------------------------------
  **CATEGORY: FRUITS/VEGETABLES (CONT.)**

  CATEGORY TAX RATE:
  -----------------------------------------------------------------------

+-----------------------+--------+--------+--------+------------------+
| **SU                  | QU     | UNIT   | PRICE  | BRAND AND        |
| BCATEGORY:VEGETABLES, | ANTITY |        |        | DESCRIPTION      |
| FRESH**               |        | (lb    |        |                  |
|                       |        | ./kg.) |        |                  |
| TAX INCLUDED IN       |        |        |        |                  |
| REPORTED PRICE?       |        |        |        |                  |
|                       |        |        |        |                  |
|  YES  NO  N/A      |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| **MOST FREQUENTLY     |        |        |        |                  |
| USED OUTLET**         |        |        |        |                  |
|                       |        |        |        |                  |
| NAME(S):              |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 1\. Potatoes, White   |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 2\. Potatoes, Baking  |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 3\. Beans, Green      |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 4\. Cabbage           |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 5\. Carrots           |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 6\. Eggplant          |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 7\. Lettuce           |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 8\. Onions            |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 9\. Squash            |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 10\. Tomatoes         |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 11\. Broccoli         |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| **Comments:**         |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| **SECOND MOST USED    |        |        |        |                  |
| OUTLET**              |        |        |        |                  |
|                       |        |        |        |                  |
| NAME(S):              |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 1\. Potatoes, White   |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 2\. Potatoes, Baking  |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 3\. Beans, Green      |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 4\. Cabbage           |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 5\. Carrots           |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 6\. Eggplant          |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 7\. Lettuce           |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 8\. Onions            |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 9\. Squash            |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 10\. Tomatoes         |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 11\. Broccoli         |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| **Comments:**         |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+

FRUITS AND VEGETABLES

  -----------------------------------------------------------------------
  **CATEGORY: FRUITS/VEGETABLES (CONT.)**

  CATEGORY TAX RATE:
  -----------------------------------------------------------------------

+-----------------------+--------+--------+--------+------------------+
| **SUBCATEGORY: FRUIT, | QU     | UNIT   | PRICE  | BRAND AND        |
| CANNED**              | ANTITY |        |        | DESCRIPTION      |
|                       |        | (gram/ |        |                  |
| TAX INCLUDED IN       |        | ounce) |        |                  |
| REPORTED PRICE?       |        |        |        |                  |
|                       |        |        |        |                  |
|  YES  NO  N/A      |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| **MOST FREQUENTLY     |        |        |        |                  |
| USED OUTLET**         |        |        |        |                  |
|                       |        |        |        |                  |
| NAME(S):              |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 1\. Applesauce        |        |        |        |                  |
| (822-879gr/29-31oz.)  |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 2\. Peaches           |        |        |        |                  |
| (822-879gr/29-31oz.)  |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 3\. Pineapples        |        |        |        |                  |
| (822-879gr/29-31oz.)  |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 4\. Pears             |        |        |        |                  |
| (822-879gr/29-31oz.)  |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| **Comments:**         |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| **SECOND MOST USED    |        |        |        |                  |
| OUTLET**              |        |        |        |                  |
|                       |        |        |        |                  |
| NAME(S):              |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 1\. Applesauce        |        |        |        |                  |
| (822-879gr./29-31oz.) |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 2\. Peaches           |        |        |        |                  |
| (822-879gr./29-31oz.) |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 3\. Pineapples        |        |        |        |                  |
| (822-879gr./29-31oz.) |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 4\. Pears             |        |        |        |                  |
| (822-879gr./29-31oz.) |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| **Comments:**         |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+

+-----------------------+--------+--------+--------+------------------+
| **SUBCATEGORY:        | QU     | UNIT   | PRICE  | BRAND AND        |
| VEGETABLES, CANNED**  | ANTITY |        |        | DESCRIPTION      |
|                       |        | (gram/ |        |                  |
| TAX INCLUDED IN       |        | ounce) |        |                  |
| REPORTED PRICE?       |        |        |        |                  |
|                       |        |        |        |                  |
|  YES  NO  N/A      |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| **MOST FREQUENTLY     |        |        |        |                  |
| USED OUTLET**         |        |        |        |                  |
|                       |        |        |        |                  |
| NAME(S):              |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 1\. Beans, String     |        |        |        |                  |
| (425-482gr./15-17oz.) |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 2\. Peas, Green       |        |        |        |                  |
| (425-482gr./15-17oz.) |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 3\. Corn              |        |        |        |                  |
| (425-482gr./15-17oz.) |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 4\. Tomatoes          |        |        |        |                  |
| (425-482gr./15-17oz.) |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| **Comments:**         |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+

FRUITS AND VEGETABLES

  -----------------------------------------------------------------------
  **CATEGORY: FRUITS/VEGETABLES (CONT.)**

  CATEGORY TAX RATE:
  -----------------------------------------------------------------------

+-----------------------+--------+--------+--------+------------------+
| VEGETABLES, CANNED    |        |        |        |                  |
| (Cont.)               |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| **SECOND MOST USED    |        |        |        |                  |
| OUTLET**              |        |        |        |                  |
|                       |        |        |        |                  |
| NAME(S):              |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 1\. Beans, String     |        |        |        |                  |
| (425-482gr./15-17oz.) |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 2\. Peas, Green       |        |        |        |                  |
| (425-482gr./15-17oz.) |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 3\. Corn              |        |        |        |                  |
| (425-482gr./15-17oz.) |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 4\. Tomatoes          |        |        |        |                  |
| (425-482gr./15-17oz.) |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| **Comments:**         |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+

+-----------------------+--------+--------+--------+------------------+
| **SUBCATEGORY:        | QU     | UNIT   | PRICE  | BRAND AND        |
| VEGETABLES, FROZEN**  | ANTITY |        |        | DESCRIPTION      |
|                       |        | (gram/ |        |                  |
| TAX INCLUDED IN       |        | ounce) |        |                  |
| REPORTED PRICE?       |        |        |        |                  |
|                       |        |        |        |                  |
|  YES  NO  N/A      |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| **MOST FREQUENTLY     |        |        |        |                  |
| USED OUTLET**         |        |        |        |                  |
|                       |        |        |        |                  |
| NAME(S):              |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 1\. Spinach           |        |        |        |                  |
| (284gr./10oz.)        |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 2\. Beans, String     |        |        |        |                  |
| (284gr./10oz.)        |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 3\. Peas, Green       |        |        |        |                  |
| (284gr./10oz.)        |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 4\. French Fries      |        |        |        |                  |
| (284gr./10oz.)        |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| **Comments:**         |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| **SECOND MOST USED    |        |        |        |                  |
| OUTLET**              |        |        |        |                  |
|                       |        |        |        |                  |
| NAME(S):              |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 1\. Spinach           |        |        |        |                  |
| (284gr./10oz.)        |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 2\. Beans, String     |        |        |        |                  |
| (284gr./10oz.)        |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 3\. Peas, Green       |        |        |        |                  |
| (284gr./10oz.)        |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 4\. French Fries      |        |        |        |                  |
| (284gr./10oz.)        |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| **Comments:**         |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+

FRUITS AND VEGETABLES

  -----------------------------------------------------------------------
  **CATEGORY: CLOTHING**

  CATEGORY TAX RATE:
  -----------------------------------------------------------------------

+---------------+------+--------+-------------------------------------+
| *             |      | PRICE  | BRAND, COUNTRY OF ORIGIN, AND       |
| *SUBCATEGORY: |      |        | DESCRIPTION                         |
| MEN\'S        |      |        |                                     |
| CLOTHING**    |      |        |                                     |
|               |      |        |                                     |
| TAX INCLUDED  |      |        |                                     |
| IN REPORTED   |      |        |                                     |
| PRICE?        |      |        |                                     |
|               |      |        |                                     |
|  YES  NO   |      |        |                                     |
| N/A           |      |        |                                     |
+---------------+------+--------+-------------------------------------+
| **MOST        |      |        |                                     |
| FREQUENTLY    |      |        |                                     |
| USED OUTLET** |      |        |                                     |
|               |      |        |                                     |
| NAME(S):      |      |        |                                     |
+---------------+------+--------+-------------------------------------+
| 1\. Slacks,   | Typ  |        |                                     |
| Man\'s Dress  | ical |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Su   |        |                                     |
|               | bsti |        |                                     |
|               | tute |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Eco  |        |                                     |
|               | nomy |        |                                     |
+---------------+------+--------+-------------------------------------+
| 2\. Shirt,    | Typ  |        |                                     |
| Man\'s Dress  | ical |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Su   |        |                                     |
|               | bsti |        |                                     |
|               | tute |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Eco  |        |                                     |
|               | nomy |        |                                     |
+---------------+------+--------+-------------------------------------+
| 3\. Shoes,    | Typ  |        |                                     |
| Man\'s Dress  | ical |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Su   |        |                                     |
|               | bsti |        |                                     |
|               | tute |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Eco  |        |                                     |
|               | nomy |        |                                     |
+---------------+------+--------+-------------------------------------+
| **Comments:** |      |        |                                     |
+---------------+------+--------+-------------------------------------+
| **SECOND MOST |      |        |                                     |
| USED OUTLET** |      |        |                                     |
|               |      |        |                                     |
| NAME(S):      |      |        |                                     |
+---------------+------+--------+-------------------------------------+
| 1\. Slacks,   | Typ  |        |                                     |
| Man\'s Dress  | ical |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Su   |        |                                     |
|               | bsti |        |                                     |
|               | tute |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Eco  |        |                                     |
|               | nomy |        |                                     |
+---------------+------+--------+-------------------------------------+
| 2\. Shirt,    | Typ  |        |                                     |
| Man\'s Dress  | ical |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Su   |        |                                     |
|               | bsti |        |                                     |
|               | tute |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Eco  |        |                                     |
|               | nomy |        |                                     |
+---------------+------+--------+-------------------------------------+
| 3\. Shoes,    | Typ  |        |                                     |
| Man\'s Dress  | ical |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Su   |        |                                     |
|               | bsti |        |                                     |
|               | tute |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Eco  |        |                                     |
|               | nomy |        |                                     |
+---------------+------+--------+-------------------------------------+
| **Comments:** |      |        |                                     |
+---------------+------+--------+-------------------------------------+

CLOTHING

  -----------------------------------------------------------------------
  **CATEGORY: CLOTHING (CONT.)**

  CATEGORY TAX RATE:
  -----------------------------------------------------------------------

+---------------+------+--------+-------------------------------------+
| *             |      | PRICE  | BRAND, COUNTRY OF ORIGIN, AND       |
| *SUBCATEGORY: |      |        | DESCRIPTION                         |
| WOMEN\'S      |      |        |                                     |
| CLOTHING**    |      |        |                                     |
|               |      |        |                                     |
| TAX INCLUDED  |      |        |                                     |
| IN REPORTED   |      |        |                                     |
| PRICE?        |      |        |                                     |
|               |      |        |                                     |
|  YES  NO   |      |        |                                     |
| N/A           |      |        |                                     |
+---------------+------+--------+-------------------------------------+
| **MOST        |      |        |                                     |
| FREQUENTLY    |      |        |                                     |
| USED OUTLET** |      |        |                                     |
|               |      |        |                                     |
| NAME(S):      |      |        |                                     |
+---------------+------+--------+-------------------------------------+
| 1\. Blouse,   | Typ  |        |                                     |
| Woman\'s      | ical |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Su   |        |                                     |
|               | bsti |        |                                     |
|               | tute |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Eco  |        |                                     |
|               | nomy |        |                                     |
+---------------+------+--------+-------------------------------------+
| 2\. Skirt,    | Typ  |        |                                     |
| Woman\'s      | ical |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Su   |        |                                     |
|               | bsti |        |                                     |
|               | tute |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Eco  |        |                                     |
|               | nomy |        |                                     |
+---------------+------+--------+-------------------------------------+
| 3\. Panty     | Typ  |        |                                     |
| Hose,         | ical |        |                                     |
| Woman\'s      |      |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Su   |        |                                     |
|               | bsti |        |                                     |
|               | tute |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Eco  |        |                                     |
|               | nomy |        |                                     |
+---------------+------+--------+-------------------------------------+
| **Comments:** |      |        |                                     |
+---------------+------+--------+-------------------------------------+
| **SECOND MOST |      |        |                                     |
| USED OUTLET** |      |        |                                     |
|               |      |        |                                     |
| NAME(S):      |      |        |                                     |
+---------------+------+--------+-------------------------------------+
| 1\. Blouse,   | Typ  |        |                                     |
| Woman\'s      | ical |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Su   |        |                                     |
|               | bsti |        |                                     |
|               | tute |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Eco  |        |                                     |
|               | nomy |        |                                     |
+---------------+------+--------+-------------------------------------+
| 2\. Skirt,    | Typ  |        |                                     |
| Woman\'s      | ical |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Su   |        |                                     |
|               | bsti |        |                                     |
|               | tute |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Eco  |        |                                     |
|               | nomy |        |                                     |
+---------------+------+--------+-------------------------------------+
| 3\. Panty     | Typ  |        |                                     |
| Hose,         | ical |        |                                     |
| Woman\'s      |      |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Su   |        |                                     |
|               | bsti |        |                                     |
|               | tute |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Eco  |        |                                     |
|               | nomy |        |                                     |
+---------------+------+--------+-------------------------------------+
| **Comments:** |      |        |                                     |
+---------------+------+--------+-------------------------------------+

CLOTHING

  -----------------------------------------------------------------------
  **CATEGORY: CLOTHING (CONT.)**

  CATEGORY TAX RATE:
  -----------------------------------------------------------------------

+---------------+------+--------+-------------------------------------+
| *             |      | PRICE  | BRAND, COUNTRY OF ORIGIN, AND       |
| *SUBCATEGORY: |      |        | DESCRIPTION                         |
| CHILDREN\'S** |      |        |                                     |
|               |      |        |                                     |
| **CLOTHING**  |      |        |                                     |
|               |      |        |                                     |
| TAX INCLUDED  |      |        |                                     |
| IN REPORTED   |      |        |                                     |
| PRICE?        |      |        |                                     |
|               |      |        |                                     |
|  YES  NO   |      |        |                                     |
| N/A           |      |        |                                     |
+---------------+------+--------+-------------------------------------+
| **MOST        |      |        |                                     |
| FREQUENTLY    |      |        |                                     |
| USED OUTLET** |      |        |                                     |
|               |      |        |                                     |
| NAME(S):      |      |        |                                     |
+---------------+------+--------+-------------------------------------+
| 1\. Jeans,    | Typ  |        |                                     |
| Child\'s      | ical |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Su   |        |                                     |
|               | bsti |        |                                     |
|               | tute |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Eco  |        |                                     |
|               | nomy |        |                                     |
+---------------+------+--------+-------------------------------------+
| 2\. Shoes,    | Typ  |        |                                     |
| Child\'s      | ical |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Su   |        |                                     |
|               | bsti |        |                                     |
|               | tute |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Eco  |        |                                     |
|               | nomy |        |                                     |
+---------------+------+--------+-------------------------------------+
| **Comments:** |      |        |                                     |
+---------------+------+--------+-------------------------------------+
| **SECOND MOST |      |        |                                     |
| USED OUTLET** |      |        |                                     |
|               |      |        |                                     |
| NAME(S):      |      |        |                                     |
+---------------+------+--------+-------------------------------------+
| 1\. Jeans,    | Typ  |        |                                     |
| Child\'s      | ical |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Su   |        |                                     |
|               | bsti |        |                                     |
|               | tute |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Eco  |        |                                     |
|               | nomy |        |                                     |
+---------------+------+--------+-------------------------------------+
| 2\. Shoes,    | Typ  |        |                                     |
| Child\'s      | ical |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Su   |        |                                     |
|               | bsti |        |                                     |
|               | tute |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Eco  |        |                                     |
|               | nomy |        |                                     |
+---------------+------+--------+-------------------------------------+
| **Comments:** |      |        |                                     |
+---------------+------+--------+-------------------------------------+

CLOTHING

  -----------------------------------------------------------------------
  **CATEGORY: PERSONAL CARE**

  CATEGORY TAX RATE:
  -----------------------------------------------------------------------

+---------------+------+--------+--------+--------+------------------+
| *             |      | QU     | UNIT   | PRICE  | BRAND AND        |
| *SUBCATEGORY: |      | ANTITY |        |        | DESCRIPTION      |
| TOILETRIES**  |      |        |        |        |                  |
|               |      |        |        |        |                  |
| TAX INCLUDED  |      |        |        |        |                  |
| IN REPORTED   |      |        |        |        |                  |
| PRICE?        |      |        |        |        |                  |
|               |      |        |        |        |                  |
|  YES  NO   |      |        |        |        |                  |
| N/A           |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **MOST        |      |        |        |        |                  |
| FREQUENTLY    |      |        |        |        |                  |
| USED OUTLET** |      |        |        |        |                  |
|               |      |        |        |        |                  |
| NAME(S):      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 1\.           | Typ  |        |        |        |                  |
| Toothpaste    | ical |        |        |        |                  |
| (198g/7oz.)   |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 2\. Razor     | Typ  |        |        |        |                  |
| Blades        | ical |        |        |        |                  |
|               |      |        |        |        |                  |
| (pkg. of 5-10 |      |        |        |        |                  |
| twin blades)  |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 3\. Sanitary  | Typ  |        |        |        |                  |
| Napkins       | ical |        |        |        |                  |
|               |      |        |        |        |                  |
| (box of 24)   |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 4\. Hair      | Typ  |        |        |        |                  |
| Shampoo       | ical |        |        |        |                  |
|               |      |        |        |        |                  |
| (450ml/16     |      |        |        |        |                  |
| fluid oz.)    |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **Comments:** |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **SECOND MOST |      |        |        |        |                  |
| USED OUTLET** |      |        |        |        |                  |
|               |      |        |        |        |                  |
| NAME(S):      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 1\.           | Typ  |        |        |        |                  |
| Toothpaste    | ical |        |        |        |                  |
| (198g/7oz.)   |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 2\. Razor     | Typ  |        |        |        |                  |
| Blades        | ical |        |        |        |                  |
|               |      |        |        |        |                  |
| (pkg. of 5-10 |      |        |        |        |                  |
| twin blades)  |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 3\. Sanitary  | Typ  |        |        |        |                  |
| Napkins       | ical |        |        |        |                  |
|               |      |        |        |        |                  |
| (box of 24)   |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 4\. Hair      | Typ  |        |        |        |                  |
| Shampoo       | ical |        |        |        |                  |
|               |      |        |        |        |                  |
| (450ml/16     |      |        |        |        |                  |
| fluid oz.)    |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **Comments:** |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+

PERSONAL CARE

  -----------------------------------------------------------------------
  **CATEGORY: PERSONAL CARE (CONT.)**

  CATEGORY TAX RATE:
  -----------------------------------------------------------------------

+-----------------------+--------+-------------------------------------+
| **SUBCATEGORY: DRY    | PRICE  | DESCRIPTION                         |
| CLEANING**            |        |                                     |
|                       |        |                                     |
| TAX INCLUDED IN       |        |                                     |
| REPORTED PRICE?       |        |                                     |
|                       |        |                                     |
|  YES  NO  N/A      |        |                                     |
+-----------------------+--------+-------------------------------------+
| **MOST FREQUENTLY     |        |                                     |
| USED OUTLET**         |        |                                     |
|                       |        |                                     |
| NAME(S):              |        |                                     |
+-----------------------+--------+-------------------------------------+
| 1\. Launder Man\'s    |        |                                     |
| Shirt                 |        |                                     |
+-----------------------+--------+-------------------------------------+
| 2\. Dry Cleaning,     |        |                                     |
| Man\'s Slacks         |        |                                     |
+-----------------------+--------+-------------------------------------+
| **Comments:**         |        |                                     |
+-----------------------+--------+-------------------------------------+
| **SECOND MOST USED    |        |                                     |
| OUTLET**              |        |                                     |
|                       |        |                                     |
| NAME(S):              |        |                                     |
+-----------------------+--------+-------------------------------------+
| 1\. Launder Man\'s    |        |                                     |
| Shirt                 |        |                                     |
+-----------------------+--------+-------------------------------------+
| 2\. Dry Cleaning,     |        |                                     |
| Man\'s Slacks         |        |                                     |
+-----------------------+--------+-------------------------------------+
| **Comments:**         |        |                                     |
+-----------------------+--------+-------------------------------------+
| **SPECIAL             |        |                                     |
| ARRANGEMENTS FOR      |        |                                     |
| GOVERNMENT            |        |                                     |
| EMPLOYEES**           |        |                                     |
|                       |        |                                     |
| NAME(S):              |        |                                     |
+-----------------------+--------+-------------------------------------+
| 1\. Launder Man\'s    |        |                                     |
| Shirt                 |        |                                     |
+-----------------------+--------+-------------------------------------+
| 2\. Dry Cleaning,     |        |                                     |
| Man\'s Slacks         |        |                                     |
+-----------------------+--------+-------------------------------------+
| **Comments:**         |        |                                     |
+-----------------------+--------+-------------------------------------+

PERSONAL CARE

  -----------------------------------------------------------------------
  **CATEGORYP PERSONAL CARE (CONT.)**

  CATEGORY TAX RATE:
  -----------------------------------------------------------------------

+-----------------------+--------+--------+---------------------------+
| **SUBCATEGORY: HAIR   | PRICE  | TIP    | DESCRIPTION               |
| SERVICES**            |        |        |                           |
|                       |        |        |                           |
| TAX INCLUDED IN       |        |        |                           |
| REPORTED PRICE?       |        |        |                           |
|                       |        |        |                           |
|  YES  NO  N/A      |        |        |                           |
+-----------------------+--------+--------+---------------------------+
| **MOST FREQUENTLY     |        |        |                           |
| USED OUTLET**         |        |        |                           |
|                       |        |        |                           |
| NAME(S):              |        |        |                           |
+-----------------------+--------+--------+---------------------------+
| 1\. Haircut, Man\'s   |        |        |                           |
| Regular               |        |        |                           |
+-----------------------+--------+--------+---------------------------+
| 2\. Shampoo, Haircut, |        |        |                           |
| & Blow Dry,           |        |        |                           |
|                       |        |        |                           |
| Woman\'s              |        |        |                           |
+-----------------------+--------+--------+---------------------------+
| 3\. Permanent,        |        |        |                           |
| Woman\'s              |        |        |                           |
+-----------------------+--------+--------+---------------------------+
| 4\. Haircut, Child\'s |        |        |                           |
+-----------------------+--------+--------+---------------------------+
| **Comments:**         |        |        |                           |
+-----------------------+--------+--------+---------------------------+
| **SECOND MOST USED    |        |        |                           |
| OUTLET**              |        |        |                           |
|                       |        |        |                           |
| NAME(S):              |        |        |                           |
+-----------------------+--------+--------+---------------------------+
| 1\. Haircut, Man\'s   |        |        |                           |
| Regular               |        |        |                           |
+-----------------------+--------+--------+---------------------------+
| 2\. Shampoo, Haircut, |        |        |                           |
| & Blow Dry,           |        |        |                           |
|                       |        |        |                           |
| Woman\'s              |        |        |                           |
+-----------------------+--------+--------+---------------------------+
| 3\. Permanent,        |        |        |                           |
| Woman\'s              |        |        |                           |
+-----------------------+--------+--------+---------------------------+
| 4\. Haircut, Child\'s |        |        |                           |
+-----------------------+--------+--------+---------------------------+
| **Comments:**         |        |        |                           |
+-----------------------+--------+--------+---------------------------+
| **SPECIAL             |        |        |                           |
| ARRANGEMENTS FOR      |        |        |                           |
| GOVERNMENT            |        |        |                           |
| EMPLOYEES**           |        |        |                           |
|                       |        |        |                           |
| NAME(S):              |        |        |                           |
+-----------------------+--------+--------+---------------------------+
| 1\. Haircut, Man\'s   |        |        |                           |
| Regular               |        |        |                           |
+-----------------------+--------+--------+---------------------------+
| 2\. Shampoo, Haircut, |        |        |                           |
| & Blow Dry,           |        |        |                           |
|                       |        |        |                           |
| Woman\'s              |        |        |                           |
+-----------------------+--------+--------+---------------------------+
| 3\. Permanent,        |        |        |                           |
| Woman\'s              |        |        |                           |
+-----------------------+--------+--------+---------------------------+
| 4\. Haircut, Child\'s |        |        |                           |
+-----------------------+--------+--------+---------------------------+
| **Comments:**         |        |        |                           |
+-----------------------+--------+--------+---------------------------+

PERSONAL CARE

  -----------------------------------------------------------------------
  **CATEGORY: FURNISHINGS/HOUSEHOLD**

  CATEGORY TAX RATE:
  -----------------------------------------------------------------------

+---------------+------+--------+-------------------------------------+
| *             |      | PRICE  | BRAND AND DESCRIPTION               |
| *SUBCATEGORY: |      |        |                                     |
| HOUSEHOLD**   |      |        |                                     |
|               |      |        |                                     |
| *             |      |        |                                     |
| *APPLIANCES** |      |        |                                     |
|               |      |        |                                     |
| TAX INCLUDED  |      |        |                                     |
| IN REPORTED   |      |        |                                     |
| PRICE?        |      |        |                                     |
|               |      |        |                                     |
|  YES  NO   |      |        |                                     |
| N/A           |      |        |                                     |
+---------------+------+--------+-------------------------------------+
| **MOST        |      |        |                                     |
| FREQUENTLY    |      |        |                                     |
| USED OUTLET** |      |        |                                     |
|               |      |        |                                     |
| NAME(S):      |      |        |                                     |
+---------------+------+--------+-------------------------------------+
| 1\.           | Typ  |        |                                     |
| Microwave,    | ical |        |                                     |
| Portable      |      |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Su   |        |                                     |
|               | bsti |        |                                     |
|               | tute |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Eco  |        |                                     |
|               | nomy |        |                                     |
+---------------+------+--------+-------------------------------------+
| 2\. Toaster,  | Typ  |        |                                     |
| Two Slice     | ical |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Su   |        |                                     |
|               | bsti |        |                                     |
|               | tute |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Eco  |        |                                     |
|               | nomy |        |                                     |
+---------------+------+--------+-------------------------------------+
| 3\. Coffee    | Typ  |        |                                     |
| Maker         | ical |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Su   |        |                                     |
|               | bsti |        |                                     |
|               | tute |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Eco  |        |                                     |
|               | nomy |        |                                     |
+---------------+------+--------+-------------------------------------+
| **Comments:** |      |        |                                     |
+---------------+------+--------+-------------------------------------+
| **SECOND MOST |      |        |                                     |
| USED OUTLET** |      |        |                                     |
|               |      |        |                                     |
| NAME(S):      |      |        |                                     |
+---------------+------+--------+-------------------------------------+
| 1\.           | Typ  |        |                                     |
| Microwave,    | ical |        |                                     |
| Portable      |      |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Su   |        |                                     |
|               | bsti |        |                                     |
|               | tute |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Eco  |        |                                     |
|               | nomy |        |                                     |
+---------------+------+--------+-------------------------------------+
| 2\. Toaster,  | Typ  |        |                                     |
| Two Slice     | ical |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Su   |        |                                     |
|               | bsti |        |                                     |
|               | tute |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Eco  |        |                                     |
|               | nomy |        |                                     |
+---------------+------+--------+-------------------------------------+
| 3\. Coffee    | Typ  |        |                                     |
| Maker         | ical |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Su   |        |                                     |
|               | bsti |        |                                     |
|               | tute |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Eco  |        |                                     |
|               | nomy |        |                                     |
+---------------+------+--------+-------------------------------------+
| **Comments:** |      |        |                                     |
+---------------+------+--------+-------------------------------------+

FURNISHINGS/HOUSEHOLD

  -----------------------------------------------------------------------
  **CATEGORY: FURNISHINGS/HOUSEHOLD (CONT.)**

  CATEGORY TAX RATE:
  -----------------------------------------------------------------------

+---------------+------+--------+-------------------------------------+
| *             |      | PRICE  | BRAND AND DESCRIPTION               |
| *SUBCATEGORY: |      |        |                                     |
| WASHING       |      |        |                                     |
| MACHINE**     |      |        |                                     |
|               |      |        |                                     |
| TAX INCLUDED  |      |        |                                     |
| IN REPORTED   |      |        |                                     |
| PRICE?        |      |        |                                     |
|               |      |        |                                     |
|  YES  NO   |      |        |                                     |
| N/A           |      |        |                                     |
+---------------+------+--------+-------------------------------------+
| **MOST        |      |        |                                     |
| FREQUENTLY    |      |        |                                     |
| USED OUTLET** |      |        |                                     |
|               |      |        |                                     |
| NAME(S):      |      |        |                                     |
+---------------+------+--------+-------------------------------------+
| Washing       | Typ  |        |                                     |
| Machine       | ical |        |                                     |
|               |      |        |                                     |
| (specify      |      |        |                                     |
| capacity)     |      |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Su   |        |                                     |
|               | bsti |        |                                     |
|               | tute |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Eco  |        |                                     |
|               | nomy |        |                                     |
+---------------+------+--------+-------------------------------------+
| **Comments:** |      |        |                                     |
+---------------+------+--------+-------------------------------------+
| **SECOND MOST |      |        |                                     |
| USED OUTLET** |      |        |                                     |
|               |      |        |                                     |
| NAME(S):      |      |        |                                     |
+---------------+------+--------+-------------------------------------+
| Washing       | Typ  |        |                                     |
| Machine       | ical |        |                                     |
|               |      |        |                                     |
| (specify      |      |        |                                     |
| capacity)     |      |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Su   |        |                                     |
|               | bsti |        |                                     |
|               | tute |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Eco  |        |                                     |
|               | nomy |        |                                     |
+---------------+------+--------+-------------------------------------+
| **Comments:** |      |        |                                     |
+---------------+------+--------+-------------------------------------+

+---------------+------+--------+--------+--------+------------------+
| *             |      | QU     | UNIT   | PRICE  | BRAND AND        |
| *SUBCATEGORY: |      | ANTITY |        |        | DESCRIPTION      |
| HOUSEHOLD**   |      |        |        |        |                  |
|               |      |        |        |        |                  |
| **            |      |        |        |        |                  |
| CONSUMABLES** |      |        |        |        |                  |
|               |      |        |        |        |                  |
| TAX INCLUDED  |      |        |        |        |                  |
| IN REPORTED   |      |        |        |        |                  |
| PRICE?        |      |        |        |        |                  |
|               |      |        |        |        |                  |
|  YES  NO   |      |        |        |        |                  |
| N/A           |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **MOST        |      |        |        |        |                  |
| FREQUENTLY    |      |        |        |        |                  |
| USED OUTLET** |      |        |        |        |                  |
|               |      |        |        |        |                  |
| NAME(S):      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 1\. Laundry   | Typ  |        |        |        |                  |
| Detergent,    | ical |        |        |        |                  |
|               |      |        |        |        |                  |
| Liquid or     |      |        |        |        |                  |
| Powdered      |      |        |        |        |                  |
|               |      |        |        |        |                  |
| (ml/fl.oz. or |      |        |        |        |                  |
| gr./oz.)      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 2\. Toilet    | Typ  |        |        |        |                  |
| Tissue        | ical |        |        |        |                  |
| (specify \#   |      |        |        |        |                  |
| of            |      |        |        |        |                  |
|               |      |        |        |        |                  |
| rolls and     |      |        |        |        |                  |
| sheets per    |      |        |        |        |                  |
| roll)         |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 3\. Diapers,  | Typ  |        |        |        |                  |
| Disposable    | ical |        |        |        |                  |
|               |      |        |        |        |                  |
| (package of   |      |        |        |        |                  |
| 48)           |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **Comments:** |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+

FURNISHINGS/HOUSEHOLD

  -----------------------------------------------------------------------
  **CATEGORY: FURNISHINGS/HOUSEHOLD (CONT.)**

  CATEGORY TAX RATE:
  -----------------------------------------------------------------------

+---------------+------+--------+--------+--------+------------------+
| SUBCATEGORY:  |      |        |        |        |                  |
| HOUSEHOLD     |      |        |        |        |                  |
| CONSUMABLES   |      |        |        |        |                  |
| (Cont.):      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **SECOND MOST |      |        |        |        |                  |
| USED OUTLET** |      |        |        |        |                  |
|               |      |        |        |        |                  |
| NAME(S):      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 1\. Laundry   | Typ  |        |        |        |                  |
| Detergent,    | ical |        |        |        |                  |
|               |      |        |        |        |                  |
| Liquid or     |      |        |        |        |                  |
| Powdered      |      |        |        |        |                  |
|               |      |        |        |        |                  |
| (ml/fl.oz. or |      |        |        |        |                  |
| gr./oz.)      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 2\. Toilet    | Typ  |        |        |        |                  |
| Tissue        | ical |        |        |        |                  |
| (specify \#   |      |        |        |        |                  |
| of            |      |        |        |        |                  |
|               |      |        |        |        |                  |
| rolls and     |      |        |        |        |                  |
| sheets per    |      |        |        |        |                  |
| roll)         |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 3\. Diapers,  | Typ  |        |        |        |                  |
| Disposable    | ical |        |        |        |                  |
|               |      |        |        |        |                  |
| (package of   |      |        |        |        |                  |
| 48)           |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **Comments:** |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+

+-----------------------+-----+---------+--------+-----+-------------+
| **SUBCATEGORY:        | FI  | NUMBER  | PRICE  | LEN | DESCRIPTION |
| TELEPHONE SERVICE**   | XED | OF      |        | GTH |             |
|                       |     |         | PER    |     |             |
| **(Local and Long     | C   | LOCAL   |        | OF  |             |
| Distance Service)**   | OST |         | ADDI   |     |             |
|                       |     | CALLS   | TIONAL | LO  |             |
| TAX INCLUDED IN       |     |         |        | CAL |             |
| REPORTED PRICE?       |     | I       | LOCAL  |     |             |
|                       |     | NCLUDED |        | CA  |             |
|  YES  NO  N/A      |     | IN      | CALL   | LLS |             |
|                       |     |         |        |     |             |
|                       |     | FIXED   |        |     |             |
|                       |     | COST    |        |     |             |
+-----------------------+-----+---------+--------+-----+-------------+
| 1\. Local Service     |     |         |        |     |             |
| Call Charge           |     |         |        |     |             |
+-----------------------+-----+---------+--------+-----+-------------+
| **Comments:**         |     |         |        |     |             |
|                       |     |         |        |     |             |
| **Fixed Cost is for  |     |         |        |     |             |
| monthly  bi-monthly  |     |         |        |     |             |
|  quarterly           |     |         |        |     |             |
| service.**            |     |         |        |     |             |
|                       |     |         |        |     |             |
| Report monthly,       |     |         |        |     |             |
| bi-monthly, or        |     |         |        |     |             |
| quarterly service fee |     |         |        |     |             |
| in the fixed price    |     |         |        |     |             |
| column. In the second |     |         |        |     |             |
| column, report the    |     |         |        |     |             |
| number of local       |     |         |        |     |             |
| calls, if any,        |     |         |        |     |             |
| included in the       |     |         |        |     |             |
| service fee or state  |     |         |        |     |             |
| if zero. If none are  |     |         |        |     |             |
| included in the       |     |         |        |     |             |
| service fee, report   |     |         |        |     |             |
| cost of local         |     |         |        |     |             |
| telephone call in the |     |         |        |     |             |
| third column. Provide |     |         |        |     |             |
| length of call in the |     |         |        |     |             |
| fourth column. If     |     |         |        |     |             |
| price varies by time  |     |         |        |     |             |
| of day, report both   |     |         |        |     |             |
| day and evening       |     |         |        |     |             |
| rates.                |     |         |        |     |             |
+-----------------------+-----+---------+--------+-----+-------------+
| 2\. Three minute Long | Co  |         |        |     |             |
| Distance              | st: |         |        |     |             |
|                       |     |         |        |     |             |
| Call to the U.S.      |     |         |        |     |             |
+-----------------------+-----+---------+--------+-----+-------------+
| Providing Company\'s  |     |         |        |     |             |
| Name:                 |     |         |        |     |             |
|                       |     |         |        |     |             |
| **Comments:**         |     |         |        |     |             |
|                       |     |         |        |     |             |
| Report costs          |     |         |        |     |             |
| associated with a     |     |         |        |     |             |
| three minute call to  |     |         |        |     |             |
| the continental       |     |         |        |     |             |
| United States, either |     |         |        |     |             |
| in a lump sum or per  |     |         |        |     |             |
| minute with any       |     |         |        |     |             |
| connection fees.      |     |         |        |     |             |
+-----------------------+-----+---------+--------+-----+-------------+

FURNISHINGS/HOUSEHOLD

  -----------------------------------------------------------------------
  **CATEGORY: MEDICAL**

  CATEGORY TAX RATE:
  -----------------------------------------------------------------------

+---------------+------+--------+--------+--------+------------------+
| *             |      | QU     | UNIT   | PRICE  | BRAND AND        |
| *SUBCATEGORY: |      | ANTITY |        |        | DESCRIPTION      |
| MEDICINE**    |      |        |        |        |                  |
|               |      |        |        |        |                  |
| TAX INCLUDED  |      |        |        |        |                  |
| IN REPORTED   |      |        |        |        |                  |
| PRICE?        |      |        |        |        |                  |
|               |      |        |        |        |                  |
|  YES  NO   |      |        |        |        |                  |
| N/A           |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **MOST        |      |        |        |        |                  |
| FREQUENTLY    |      |        |        |        |                  |
| USED OUTLET** |      |        |        |        |                  |
|               |      |        |        |        |                  |
| NAME(S):      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 1\. Pain      | Typ  |        |        |        |                  |
| Reliever      | ical |        |        |        |                  |
| Compound      |      |        |        |        |                  |
|               |      |        |        |        |                  |
| 100 tabs, 325 |      |        |        |        |                  |
| mg strength   |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 2\.           | Typ  |        |        |        |                  |
| Tetracycline, | ical |        |        |        |                  |
| Prescription  |      |        |        |        |                  |
|               |      |        |        |        |                  |
| 24 tabs, 250  |      |        |        |        |                  |
| mg strength   |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 3\. Insulin,  | Typ  |        |        |        |                  |
| Prescription  | ical |        |        |        |                  |
|               |      |        |        |        |                  |
| 10cc, 100     |      |        |        |        |                  |
| unit strength |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **Comments:** |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **SECOND MOST |      |        |        |        |                  |
| USED OUTLET** |      |        |        |        |                  |
|               |      |        |        |        |                  |
| NAME(S):      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 1\. Pain      | Typ  |        |        |        |                  |
| Reliever      | ical |        |        |        |                  |
| Compound      |      |        |        |        |                  |
|               |      |        |        |        |                  |
| 100 tabs, 325 |      |        |        |        |                  |
| mg strength   |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 2\.           | Typ  |        |        |        |                  |
| Tetracycline, | ical |        |        |        |                  |
| Prescription  |      |        |        |        |                  |
|               |      |        |        |        |                  |
| 24 tabs, 250  |      |        |        |        |                  |
| mg strength   |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| 3\. Insulin,  | Typ  |        |        |        |                  |
| Prescription  | ical |        |        |        |                  |
|               |      |        |        |        |                  |
| 10cc, 100     |      |        |        |        |                  |
| unit strength |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **Comments:** |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+

MEDICAL

  -----------------------------------------------------------------------
  **CATEGORY: MEDICAL (CONT.)**

  CATEGORY TAX RATE:
  -----------------------------------------------------------------------

+-----------------------+--------+-------------------------------------+
| **SUBCATEGORY:        | PRICE  | DESCRIPTION                         |
| DOCTOR**              |        |                                     |
|                       |        |                                     |
| TAX INCLUDED IN       |        |                                     |
| REPORTED PRICE?       |        |                                     |
|                       |        |                                     |
|  YES  NO  N/A      |        |                                     |
+-----------------------+--------+-------------------------------------+
| **MOST FREQUENTLY     |        |                                     |
| USED OUTLET**         |        |                                     |
|                       |        |                                     |
| NAME(S):              |        |                                     |
+-----------------------+--------+-------------------------------------+
| 1\. General           |        |                                     |
| Practioner, General   |        |                                     |
| Visit                 |        |                                     |
+-----------------------+--------+-------------------------------------+
| 2\. Pediatrician,     |        |                                     |
| General Visit         |        |                                     |
+-----------------------+--------+-------------------------------------+
| **Comments:**         |        |                                     |
+-----------------------+--------+-------------------------------------+
| **SECOND MOST USED    |        |                                     |
| OUTLET**              |        |                                     |
|                       |        |                                     |
| NAME(S):              |        |                                     |
+-----------------------+--------+-------------------------------------+
| 1\. General           |        |                                     |
| Practioner, General   |        |                                     |
| Visit                 |        |                                     |
+-----------------------+--------+-------------------------------------+
| 2\. Pediatrician,     |        |                                     |
| General Visit         |        |                                     |
+-----------------------+--------+-------------------------------------+
| **Comments:**         |        |                                     |
+-----------------------+--------+-------------------------------------+
| **SPECIAL             |        |                                     |
| ARRANGEMENTS FOR      |        |                                     |
| GOVERNMENT            |        |                                     |
| EMPLOYEES**           |        |                                     |
|                       |        |                                     |
| NAME(S):              |        |                                     |
+-----------------------+--------+-------------------------------------+
| 1\. General           |        |                                     |
| Practioner, General   |        |                                     |
| Visit                 |        |                                     |
+-----------------------+--------+-------------------------------------+
| 2\. Pediatrician,     |        |                                     |
| General Visit         |        |                                     |
+-----------------------+--------+-------------------------------------+
| **Comments:**         |        |                                     |
|                       |        |                                     |
| **Number of visits by |        |                                     |
| State Department      |        |                                     |
| Regional Medical      |        |                                     |
| Officer (RMO) to post |        |                                     |
| in the past twelve    |        |                                     |
| months:               |        |                                     |
| \_\_\_\_              |        |                                     |
| \_\_\_\_\_\_\_\_\_.** |        |                                     |
|                       |        |                                     |
| **Is there a State    |        |                                     |
| Department Nurse      |        |                                     |
| Practitioner resident |        |                                     |
| at post?  Yes  No** |        |                                     |
+-----------------------+--------+-------------------------------------+

MEDICAL

  -----------------------------------------------------------------------
  **CATEGORY: MEDICAL (CONT.)**

  CATEGORY TAX RATE:
  -----------------------------------------------------------------------

+-----------------------+--------+-------------------------------------+
| **SUBCATEGORY:        | PRICE  | DESCRIPTION                         |
| DENTIST**             |        |                                     |
|                       |        |                                     |
| TAX INCLUDED IN       |        |                                     |
| REPORTED PRICE?       |        |                                     |
|                       |        |                                     |
|  YES  NO  N/A      |        |                                     |
+-----------------------+--------+-------------------------------------+
| **MOST FREQUENTLY     |        |                                     |
| USED OUTLET**         |        |                                     |
|                       |        |                                     |
| NAME(S):              |        |                                     |
+-----------------------+--------+-------------------------------------+
| 1\. Filling, Simple   |        |                                     |
| One Surface           |        |                                     |
+-----------------------+--------+-------------------------------------+
| 2\. Extraction,       |        |                                     |
| Simple                |        |                                     |
+-----------------------+--------+-------------------------------------+
| 3\. Prophylaxis       |        |                                     |
+-----------------------+--------+-------------------------------------+
| 4\. X-ray             |        |                                     |
+-----------------------+--------+-------------------------------------+
| **Comments:**         |        |                                     |
+-----------------------+--------+-------------------------------------+
| **SECOND MOST USED    |        |                                     |
| OUTLET**              |        |                                     |
|                       |        |                                     |
| NAME(S):              |        |                                     |
+-----------------------+--------+-------------------------------------+
| 1\. Filling, Simple   |        |                                     |
| One Surface           |        |                                     |
+-----------------------+--------+-------------------------------------+
| 2\. Extraction,       |        |                                     |
| Simple                |        |                                     |
+-----------------------+--------+-------------------------------------+
| 3\. Prophylaxis       |        |                                     |
+-----------------------+--------+-------------------------------------+
| 4\. X-ray             |        |                                     |
+-----------------------+--------+-------------------------------------+
| **Comments:**         |        |                                     |
+-----------------------+--------+-------------------------------------+
| **SPECIAL             |        |                                     |
| ARRANGEMENTS FOR      |        |                                     |
| GOVERNMENT            |        |                                     |
| EMPLOYEES**           |        |                                     |
|                       |        |                                     |
| NAME(S):              |        |                                     |
+-----------------------+--------+-------------------------------------+
| 1\. Filling, Simple   |        |                                     |
| One Surface           |        |                                     |
+-----------------------+--------+-------------------------------------+
| 2\. Extraction,       |        |                                     |
| Simple                |        |                                     |
+-----------------------+--------+-------------------------------------+
| 3\. Prophylaxis       |        |                                     |
+-----------------------+--------+-------------------------------------+
| 4\. X-ray             |        |                                     |
+-----------------------+--------+-------------------------------------+
| **Comments:**         |        |                                     |
+-----------------------+--------+-------------------------------------+

+-----------------------+--------+-------------------------------------+
| **SUBCATEGORY:        | PRICE  | DESCRIPTION                         |
| HOSPITAL FACILITIES** |        |                                     |
|                       |        |                                     |
| TAX INCLUDED IN       |        |                                     |
| REPORTED PRICE?       |        |                                     |
|                       |        |                                     |
|  YES  NO  N/A      |        |                                     |
+-----------------------+--------+-------------------------------------+
| **MOST FREQUENTLY     |        |                                     |
| USED OUTLET**         |        |                                     |
|                       |        |                                     |
| NAME(S):              |        |                                     |
+-----------------------+--------+-------------------------------------+
| 1\. Private Room      |        |                                     |
+-----------------------+--------+-------------------------------------+
| 2\. Semi-Private Room |        |                                     |
+-----------------------+--------+-------------------------------------+
| **Comments:**         |        |                                     |
+-----------------------+--------+-------------------------------------+

MEDICAL

  -----------------------------------------------------------------------
  **CATEGORY: RECREATION**

  CATEGORY TAX RATE:
  -----------------------------------------------------------------------

+---------------+------+--------+-------------------------------------+
| *             |      | PRICE  | BRAND AND DESCRIPTION               |
| *SUBCATEGORY: |      |        |                                     |
| A             |      |        |                                     |
| UDIO/VISUAL** |      |        |                                     |
|               |      |        |                                     |
| **SUPPLIES**  |      |        |                                     |
|               |      |        |                                     |
| TAX INCLUDED  |      |        |                                     |
| IN REPORTED   |      |        |                                     |
| PRICE?        |      |        |                                     |
|               |      |        |                                     |
|  YES  NO   |      |        |                                     |
| N/A           |      |        |                                     |
+---------------+------+--------+-------------------------------------+
| **MOST        |      |        |                                     |
| FREQUENTLY    |      |        |                                     |
| USED OUTLET** |      |        |                                     |
|               |      |        |                                     |
| NAME(S):      |      |        |                                     |
+---------------+------+--------+-------------------------------------+
| 1\. Video     | Typ  |        |                                     |
| Cassette      | ical |        |                                     |
| Recorder      |      |        |                                     |
|               |      |        |                                     |
| (VCR)         |      |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Su   |        |                                     |
|               | bsti |        |                                     |
|               | tute |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Eco  |        |                                     |
|               | nomy |        |                                     |
+---------------+------+--------+-------------------------------------+
| 2\. Compact   | Typ  |        |                                     |
| Disc          | ical |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Su   |        |                                     |
|               | bsti |        |                                     |
|               | tute |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Eco  |        |                                     |
|               | nomy |        |                                     |
+---------------+------+--------+-------------------------------------+
| 3\. Video     | Typ  |        |                                     |
| Tape, Blank   | ical |        |                                     |
|               |      |        |                                     |
| (VHS T-120)   |      |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Su   |        |                                     |
|               | bsti |        |                                     |
|               | tute |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Eco  |        |                                     |
|               | nomy |        |                                     |
+---------------+------+--------+-------------------------------------+
| **Comments:** |      |        |                                     |
+---------------+------+--------+-------------------------------------+
| **SECOND MOST |      |        |                                     |
| USED OUTLET** |      |        |                                     |
|               |      |        |                                     |
| NAME(S):      |      |        |                                     |
+---------------+------+--------+-------------------------------------+
| 1\. Video     | Typ  |        |                                     |
| Cassette      | ical |        |                                     |
| Recorder      |      |        |                                     |
|               |      |        |                                     |
| (VCR)         |      |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Su   |        |                                     |
|               | bsti |        |                                     |
|               | tute |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Eco  |        |                                     |
|               | nomy |        |                                     |
+---------------+------+--------+-------------------------------------+
| 2\. Compact   | Typ  |        |                                     |
| Disc          | ical |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Su   |        |                                     |
|               | bsti |        |                                     |
|               | tute |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Eco  |        |                                     |
|               | nomy |        |                                     |
+---------------+------+--------+-------------------------------------+
| 3\. Video     | Typ  |        |                                     |
| Tape, Blank   | ical |        |                                     |
|               |      |        |                                     |
| (VHS T-120)   |      |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Su   |        |                                     |
|               | bsti |        |                                     |
|               | tute |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Eco  |        |                                     |
|               | nomy |        |                                     |
+---------------+------+--------+-------------------------------------+
| **Comments:** |      |        |                                     |
+---------------+------+--------+-------------------------------------+

RECREATION

  -----------------------------------------------------------------------
  **CATEGORY: RECREATION (CONT.)**

  CATEGORY TAX RATE:
  -----------------------------------------------------------------------

+---------------+------+--------+-------------------------------------+
| *             |      | PRICE  | BRAND AND DESCRIPTION               |
| *SUBCATEGORY: |      |        |                                     |
| P             |      |        |                                     |
| HOTOGRAPHIC** |      |        |                                     |
|               |      |        |                                     |
| **SUPPLIES**  |      |        |                                     |
|               |      |        |                                     |
| TAX INCLUDED  |      |        |                                     |
| IN REPORTED   |      |        |                                     |
| PRICE?        |      |        |                                     |
|               |      |        |                                     |
|  YES  NO   |      |        |                                     |
| N/A           |      |        |                                     |
+---------------+------+--------+-------------------------------------+
| **MOST        |      |        |                                     |
| FREQUENTLY    |      |        |                                     |
| USED OUTLET** |      |        |                                     |
|               |      |        |                                     |
| NAME(S):      |      |        |                                     |
+---------------+------+--------+-------------------------------------+
| 1\. Film      | Typ  |        |                                     |
| Processing    | ical |        |                                     |
|               |      |        |                                     |
| (24 exposure, |      |        |                                     |
| 35 mm)        |      |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Su   |        |                                     |
|               | bsti |        |                                     |
|               | tute |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Eco  |        |                                     |
|               | nomy |        |                                     |
+---------------+------+--------+-------------------------------------+
| 2\. Camera    | Typ  |        |                                     |
| Film          | ical |        |                                     |
|               |      |        |                                     |
| (24 exposure, |      |        |                                     |
| 35 mm)        |      |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Su   |        |                                     |
|               | bsti |        |                                     |
|               | tute |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Eco  |        |                                     |
|               | nomy |        |                                     |
+---------------+------+--------+-------------------------------------+
| **Comments:** |      |        |                                     |
+---------------+------+--------+-------------------------------------+
| **SECOND MOST |      |        |                                     |
| USED OUTLET** |      |        |                                     |
|               |      |        |                                     |
| NAME(S):      |      |        |                                     |
+---------------+------+--------+-------------------------------------+
| 1\. Film      | Typ  |        |                                     |
| Processing    | ical |        |                                     |
|               |      |        |                                     |
| (24 exposure, |      |        |                                     |
| 35 mm)        |      |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Su   |        |                                     |
|               | bsti |        |                                     |
|               | tute |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Eco  |        |                                     |
|               | nomy |        |                                     |
+---------------+------+--------+-------------------------------------+
| 2\. Camera    | Typ  |        |                                     |
| Film          | ical |        |                                     |
|               |      |        |                                     |
| (24 exposure, |      |        |                                     |
| 35 mm)        |      |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Su   |        |                                     |
|               | bsti |        |                                     |
|               | tute |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Eco  |        |                                     |
|               | nomy |        |                                     |
+---------------+------+--------+-------------------------------------+
| **Comments:** |      |        |                                     |
+---------------+------+--------+-------------------------------------+

+---------------+------+--------+-------------------------------------+
| *             |      | PRICE  | BRAND AND DESCRIPTION               |
| *SUBCATEGORY: |      |        |                                     |
| READING       |      |        |                                     |
| MATERIAL**    |      |        |                                     |
|               |      |        |                                     |
| TAX INCLUDED  |      |        |                                     |
| IN REPORTED   |      |        |                                     |
| PRICE?        |      |        |                                     |
|               |      |        |                                     |
|  YES  NO   |      |        |                                     |
| N/A           |      |        |                                     |
+---------------+------+--------+-------------------------------------+
| **MOST        |      |        |                                     |
| FREQUENTLY    |      |        |                                     |
| USED OUTLET** |      |        |                                     |
|               |      |        |                                     |
| NAME(S):      |      |        |                                     |
+---------------+------+--------+-------------------------------------+
| 1\. Book,     | Typ  |        |                                     |
| Paperback     | ical |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Su   |        |                                     |
|               | bsti |        |                                     |
|               | tute |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Eco  |        |                                     |
|               | nomy |        |                                     |
+---------------+------+--------+-------------------------------------+

RECREATION

  -----------------------------------------------------------------------
  **CATEGORY: RECREATION (CONT.)**

  CATEGORY TAX RATE:
  -----------------------------------------------------------------------

+---------------+------+--------+-------------------------------------+
| SUBCATEGORY:  |      |        |                                     |
| READING       |      |        |                                     |
| MATERIALS     |      |        |                                     |
| (Cont.):      |      |        |                                     |
+---------------+------+--------+-------------------------------------+
| 2\.           | L    |        |                                     |
| Newspaper,    | ocal |        |                                     |
| Daily         |      |        |                                     |
+---------------+------+--------+-------------------------------------+
| 3\. News      | Typ  |        |                                     |
| Magazine,     | ical |        |                                     |
| Weekly        |      |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Su   |        |                                     |
|               | bsti |        |                                     |
|               | tute |        |                                     |
+---------------+------+--------+-------------------------------------+
| **Comments:** |      |        |                                     |
+---------------+------+--------+-------------------------------------+
| **SECOND MOST |      |        |                                     |
| USED OUTLET** |      |        |                                     |
|               |      |        |                                     |
| NAME(S):      |      |        |                                     |
+---------------+------+--------+-------------------------------------+
| 1\. Book,     | Typ  |        |                                     |
| Paperback     | ical |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Su   |        |                                     |
|               | bsti |        |                                     |
|               | tute |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Eco  |        |                                     |
|               | nomy |        |                                     |
+---------------+------+--------+-------------------------------------+
| 2\.           | L    |        |                                     |
| Newspaper,    | ocal |        |                                     |
| Daily         |      |        |                                     |
+---------------+------+--------+-------------------------------------+
| 3\. News      | Typ  |        |                                     |
| Magazine,     | ical |        |                                     |
| Weekly        |      |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Su   |        |                                     |
|               | bsti |        |                                     |
|               | tute |        |                                     |
+---------------+------+--------+-------------------------------------+
| **Comments:** |      |        |                                     |
+---------------+------+--------+-------------------------------------+

+---------------+------+--------+-------------------------------------+
| *             |      | PRICE  | BRAND AND DESCRIPTION               |
| *SUBCATEGORY: |      |        |                                     |
| R             |      |        |                                     |
| ECREATIONAL** |      |        |                                     |
|               |      |        |                                     |
| **EQUIPMENT** |      |        |                                     |
|               |      |        |                                     |
| TAX INCLUDED  |      |        |                                     |
| IN REPORTED   |      |        |                                     |
| PRICE?        |      |        |                                     |
|               |      |        |                                     |
|  YES  NO   |      |        |                                     |
| N/A           |      |        |                                     |
+---------------+------+--------+-------------------------------------+
| **MOST        |      |        |                                     |
| FREQUENTLY    |      |        |                                     |
| USED OUTLET** |      |        |                                     |
|               |      |        |                                     |
| NAME(S):      |      |        |                                     |
+---------------+------+--------+-------------------------------------+
| Bicycle       | Typ  |        |                                     |
|               | ical |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Su   |        |                                     |
|               | bsti |        |                                     |
|               | tute |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Eco  |        |                                     |
|               | nomy |        |                                     |
+---------------+------+--------+-------------------------------------+
| **Comments:** |      |        |                                     |
+---------------+------+--------+-------------------------------------+
| **SECOND MOST |      |        |                                     |
| USED OUTLET** |      |        |                                     |
|               |      |        |                                     |
| NAME(S):      |      |        |                                     |
+---------------+------+--------+-------------------------------------+
| Bicycle       | Typ  |        |                                     |
|               | ical |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Su   |        |                                     |
|               | bsti |        |                                     |
|               | tute |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Eco  |        |                                     |
|               | nomy |        |                                     |
+---------------+------+--------+-------------------------------------+
| **Comments:** |      |        |                                     |
+---------------+------+--------+-------------------------------------+

RECREATION

  -----------------------------------------------------------------------
  **CATEGORY: RECREATION (CONT.)**

  CATEGORY TAX RATE:
  -----------------------------------------------------------------------

+---------------+------+--------+-------------------------------------+
| *             |      | PRICE  | DESCRIPTION                         |
| *SUBCATEGORY: |      |        |                                     |
| R             |      |        |                                     |
| ECREATIONAL** |      |        |                                     |
|               |      |        |                                     |
| *             |      |        |                                     |
| *ACTIVITIES** |      |        |                                     |
|               |      |        |                                     |
| TAX INCLUDED  |      |        |                                     |
| IN REPORTED   |      |        |                                     |
| PRICE?        |      |        |                                     |
|               |      |        |                                     |
|  YES  NO   |      |        |                                     |
| N/A           |      |        |                                     |
+---------------+------+--------+-------------------------------------+
| **MOST        |      |        |                                     |
| FREQUENTLY    |      |        |                                     |
| USED OUTLET** |      |        |                                     |
|               |      |        |                                     |
| NAME(S):      |      |        |                                     |
+---------------+------+--------+-------------------------------------+
| 1\. Movie     | Eve  |        |                                     |
| Theater       | ning |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Mat  |        |                                     |
|               | inee |        |                                     |
+---------------+------+--------+-------------------------------------+
| 2\.           | Typ  |        |                                     |
| Performing    | ical |        |                                     |
| Arts          |      |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Eco  |        |                                     |
|               | nomy |        |                                     |
+---------------+------+--------+-------------------------------------+
| 3\. Sports    | Typ  |        |                                     |
| Events        | ical |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Eco  |        |                                     |
|               | nomy |        |                                     |
+---------------+------+--------+-------------------------------------+
| **Comments:** |      |        |                                     |
+---------------+------+--------+-------------------------------------+
| **SPECIAL     |      |        |                                     |
| ARRANGEMENTS  |      |        |                                     |
| FOR           |      |        |                                     |
| GOVERNMENT    |      |        |                                     |
| EMPLOYEES**   |      |        |                                     |
|               |      |        |                                     |
| NAME(S):      |      |        |                                     |
+---------------+------+--------+-------------------------------------+
| 1\. Movie     | Eve  |        |                                     |
| Theater       | ning |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Mat  |        |                                     |
|               | inee |        |                                     |
+---------------+------+--------+-------------------------------------+
| 2\.           | Typ  |        |                                     |
| Performing    | ical |        |                                     |
| Arts          |      |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Eco  |        |                                     |
|               | nomy |        |                                     |
+---------------+------+--------+-------------------------------------+
| 3\. Sports    | Typ  |        |                                     |
| Events        | ical |        |                                     |
+---------------+------+--------+-------------------------------------+
|               | Eco  |        |                                     |
|               | nomy |        |                                     |
+---------------+------+--------+-------------------------------------+
| **Comments:** |      |        |                                     |
+---------------+------+--------+-------------------------------------+

RECREATION

  -----------------------------------------------------------------------
  **CATEGORY: PUBLIC TRANSPORTATION**

  CATEGORY TAX RATE:
  -----------------------------------------------------------------------

+-----------------------+-------+-------+--------+---+---------------+
| **SUBCATEGORY: TAXI** | DIS   | UNIT  | PRICE  | T | DESCRIPTION   |
|                       | TANCE |       |        | I |               |
| TAX INCLUDED IN       |       | (mile |        | P |               |
| REPORTED PRICE?       |       | s/km) |        |   |               |
|                       |       |       |        | \ |               |
|  YES  NO  N/A      |       |       |        | % |               |
+-----------------------+-------+-------+--------+---+---------------+
| **MOST FREQUENTLY     |       |       |        |   |               |
| USED**                |       |       |        |   |               |
|                       |       |       |        |   |               |
| **NAME(S):**          |       |       |        |   |               |
+-----------------------+-------+-------+--------+---+---------------+
| Taxi (approx. 1 l/4   |       |       |        |   |               |
| miles/2km or 15       |       |       |        |   |               |
|                       |       |       |        |   |               |
| minutes)              |       |       |        |   |               |
+-----------------------+-------+-------+--------+---+---------------+
| **Comments:**         |       |       |        |   |               |
+-----------------------+-------+-------+--------+---+---------------+

+-----------------------+-------+-------+--------+--------------------+
| **SUBCATEGORY:        | DIS   | UNIT  | PRICE  | DESCRIPTION        |
| MUNICIPAL BUS**       | TANCE |       |        |                    |
|                       |       | (mile |        |                    |
| TAX INCLUDED IN       |       | s/km) |        |                    |
| REPORTED PRICE?       |       |       |        |                    |
|                       |       |       |        |                    |
|  YES  NO  N/A      |       |       |        |                    |
+-----------------------+-------+-------+--------+--------------------+
| **MOST FREQUENTLY     |       |       |        |                    |
| USED**                |       |       |        |                    |
|                       |       |       |        |                    |
| **NAME(S):**          |       |       |        |                    |
+-----------------------+-------+-------+--------+--------------------+
| Municipal Bus         |       |       |        |                    |
+-----------------------+-------+-------+--------+--------------------+
| **Comments:**         |       |       |        |                    |
+-----------------------+-------+-------+--------+--------------------+

+-----------------------+-------+-------+--------+--------------------+
| **SUBCATEGORY:        | DIS   | UNIT  | PRICE  | DESCRIPTION        |
| SUBWAY**              | TANCE |       |        |                    |
|                       |       | (mile |        |                    |
| TAX INCLUDED IN       |       | s/km) |        |                    |
| REPORTED PRICE?       |       |       |        |                    |
|                       |       |       |        |                    |
|  YES  NO  N/A      |       |       |        |                    |
+-----------------------+-------+-------+--------+--------------------+
| **MOST FREQUENTLY     |       |       |        |                    |
| USED**                |       |       |        |                    |
|                       |       |       |        |                    |
| **NAME(S):**          |       |       |        |                    |
+-----------------------+-------+-------+--------+--------------------+
| Subway                |       |       |        |                    |
+-----------------------+-------+-------+--------+--------------------+
| **Comments:**         |       |       |        |                    |
+-----------------------+-------+-------+--------+--------------------+

+-----------------------+-------+-------+--------+--------------------+
| **SUBCATEGORY:        | DIS   | UNIT  | PRICE  | DESCRIPTION        |
| AIRFARE**             | TANCE |       |        |                    |
|                       |       | (mile |        |                    |
| TAX INCLUDED IN       |       | s/km) |        |                    |
| REPORTED PRICE?       |       |       |        |                    |
|                       |       |       |        |                    |
|  YES  NO  N/A      |       |       |        |                    |
+-----------------------+-------+-------+--------+--------------------+
| **MOST FREQUENTLY     |       |       |        |                    |
| USED**                |       |       |        |                    |
|                       |       |       |        |                    |
| **NAME(S):**          |       |       |        |                    |
+-----------------------+-------+-------+--------+--------------------+
| Air Fare - Round trip |       |       |        |                    |
| full Fare Coach Class |       |       |        |                    |
| (to destination at    |       |       |        |                    |
| least 1,000 miles     |       |       |        |                    |
| from post.)           |       |       |        |                    |
+-----------------------+-------+-------+--------+--------------------+
| **Comments:**         |       |       |        |                    |
+-----------------------+-------+-------+--------+--------------------+

PUBLIC TRANSPORATION

  -----------------------------------------------------------------------
  **CATEGORY: PERSONALLY OWNED VEHICLE**

  CATEGORY TAX RATE:
  -----------------------------------------------------------------------

+-----------------------+--------+-------------------------------------+
| **SUBCATEGORY: AUTO   | PRICE  | DESCRIPTION                         |
| MAINTENANCE**         |        |                                     |
|                       |        |                                     |
| TAX INCLUDED IN       |        |                                     |
| REPORTED PRICE?       |        |                                     |
|                       |        |                                     |
|  YES  NO  N/A      |        |                                     |
+-----------------------+--------+-------------------------------------+
| **MOST FREQUENTLY     |        |                                     |
| USED OUTLET**         |        |                                     |
|                       |        |                                     |
| NAME(S):              |        |                                     |
+-----------------------+--------+-------------------------------------+
| 1\. Oil Change        |        |                                     |
| (labor, 5 quarts of   |        |                                     |
| oil, and              |        |                                     |
|                       |        |                                     |
| oil filter)           |        |                                     |
+-----------------------+--------+-------------------------------------+
| 2\. Motor Tune Up     |        |                                     |
+-----------------------+--------+-------------------------------------+
| 3\. Labor Charge Per  |        |                                     |
| Hour                  |        |                                     |
+-----------------------+--------+-------------------------------------+
| **Comments:**         |        |                                     |
+-----------------------+--------+-------------------------------------+
| **SECOND MOST USED    |        |                                     |
| OUTLET**              |        |                                     |
|                       |        |                                     |
| NAME(S):              |        |                                     |
+-----------------------+--------+-------------------------------------+
| 1\. Oil Change        |        |                                     |
| (labor, 5 quarts of   |        |                                     |
| oil, and              |        |                                     |
|                       |        |                                     |
| oil filter)           |        |                                     |
+-----------------------+--------+-------------------------------------+
| 2\. Motor Tune Up     |        |                                     |
+-----------------------+--------+-------------------------------------+
| 3\. Labor Charge Per  |        |                                     |
| Hour                  |        |                                     |
+-----------------------+--------+-------------------------------------+
| **Comments:**         |        |                                     |
+-----------------------+--------+-------------------------------------+
| **SPECIAL             |        |                                     |
| ARRANGEMENTS FOR      |        |                                     |
| GOVERNMENT            |        |                                     |
| EMPLOYEES**           |        |                                     |
|                       |        |                                     |
| NAME(S):              |        |                                     |
+-----------------------+--------+-------------------------------------+
| 1\. Oil Change        |        |                                     |
| (labor, 5 quarts of   |        |                                     |
| oil, and              |        |                                     |
|                       |        |                                     |
| oil filter)           |        |                                     |
+-----------------------+--------+-------------------------------------+
| 2\. Motor Tune Up     |        |                                     |
+-----------------------+--------+-------------------------------------+
| 3\. Labor Charge Per  |        |                                     |
| Hour                  |        |                                     |
+-----------------------+--------+-------------------------------------+
| **Comments:**         |        |                                     |
+-----------------------+--------+-------------------------------------+

PERSONALLY OWNED VEHICLE

  -----------------------------------------------------------------------
  **CATEGORY: PERSONALLY OWNED VEHICLE (CONT.)**

  CATEGORY TAX RATE:
  -----------------------------------------------------------------------

+---------------+---------+----------+--------------------------------+
| *             |         | UNIT     | PRICE                          |
| *SUBCATEGORY: |         |          |                                |
| AUTO FUEL**   |         | (gallo   |                                |
|               |         | n/liter) |                                |
| TAX INCLUDED  |         |          |                                |
| IN REPORTED   |         |          |                                |
| PRICE?        |         |          |                                |
|               |         |          |                                |
|  YES  NO   |         |          |                                |
| N/A           |         |          |                                |
+---------------+---------+----------+--------------------------------+
| **MOST        |         |          |                                |
| FREQUENTLY    |         |          |                                |
| USED OUTLET** |         |          |                                |
|               |         |          |                                |
| NAME(S):      |         |          |                                |
+---------------+---------+----------+--------------------------------+
| Gasoline      | Regular |          |                                |
|               | Octane  |          |                                |
+---------------+---------+----------+--------------------------------+
|               | Medium  |          |                                |
|               | Octane  |          |                                |
+---------------+---------+----------+--------------------------------+
|               | High    |          |                                |
|               | Octane  |          |                                |
+---------------+---------+----------+--------------------------------+
| **(Report     |         |          |                                |
| full local    |         |          |                                |
| retail price  |         |          |                                |
| for gasoline  |         |          |                                |
| in this       |         |          |                                |
| section.)**   |         |          |                                |
|               |         |          |                                |
| **Comments:** |         |          |                                |
+---------------+---------+----------+--------------------------------+
| **DUTY        |         |          |                                |
| -FREE/SPECIAL |         |          |                                |
| A             |         |          |                                |
| RRANGEMENTS** |         |          |                                |
|               |         |          |                                |
| NAME(S):      |         |          |                                |
+---------------+---------+----------+--------------------------------+
| Gasoline      | Regular |          |                                |
|               | Octane  |          |                                |
+---------------+---------+----------+--------------------------------+
|               | Medium  |          |                                |
|               | Octane  |          |                                |
+---------------+---------+----------+--------------------------------+
|               | High    |          |                                |
|               | Octane  |          |                                |
+---------------+---------+----------+--------------------------------+
| **(Report     |         |          |                                |
| price of      |         |          |                                |
| gasoline      |         |          |                                |
| obtained      |         |          |                                |
| duty-free \-- |         |          |                                |
| either at the |         |          |                                |
| duty          |         |          |                                |
| location,     |         |          |                                |
| with coupons  |         |          |                                |
| or a tax      |         |          |                                |
| refund        |         |          |                                |
| program at a  |         |          |                                |
| local station |         |          |                                |
| or any other  |         |          |                                |
| special       |         |          |                                |
| ar            |         |          |                                |
| rangement.)** |         |          |                                |
|               |         |          |                                |
| **Comments:** |         |          |                                |
|               |         |          |                                |
| **Percentage  |         |          |                                |
| of post/duty  |         |          |                                |
| station       |         |          |                                |
| personnel     |         |          |                                |
| eligible to   |         |          |                                |
| purchase      |         |          |                                |
| duty-free     |         |          |                                |
| gasoline,     |         |          |                                |
| through any   |         |          |                                |
| means:        |         |          |                                |
| \_\_\_        |         |          |                                |
| \_\_\_\_\_%** |         |          |                                |
+---------------+---------+----------+--------------------------------+

+---------------+------+--------+--------+--------+------------------+
| *             |      | QU     | UNIT   | PRICE  | BRAND AND        |
| *SUBCATEGORY: |      | ANTITY |        |        | DESCRIPTION      |
| AUTO TIRE**   |      |        |        |        |                  |
|               |      |        |        |        |                  |
| TAX INCLUDED  |      |        |        |        |                  |
| IN REPORTED   |      |        |        |        |                  |
| PRICE?        |      |        |        |        |                  |
|               |      |        |        |        |                  |
|  YES  NO   |      |        |        |        |                  |
| N/A           |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **MOST        |      |        |        |        |                  |
| FREQUENTLY    |      |        |        |        |                  |
| USED OUTLET** |      |        |        |        |                  |
|               |      |        |        |        |                  |
| NAME(S):      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| Tire, Radial  | Typ  |        |        |        |                  |
|               | ical |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **Comments:** |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+

PERSONALLY OWNED VEHICLE

  -----------------------------------------------------------------------
  **CATEGORY: PERSONALLY OWNED VEHICLE (CONT.)**

  CATEGORY TAX RATE:
  -----------------------------------------------------------------------

+---------------+------+--------+--------+--------+------------------+
| SUBCATEGORY:  |      |        |        |        |                  |
| AUTO TIRE     |      |        |        |        |                  |
| (Cont.)       |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **SECOND MOST |      |        |        |        |                  |
| USED OUTLET** |      |        |        |        |                  |
|               |      |        |        |        |                  |
| NAME(S):      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| Tire, Radial  | Typ  |        |        |        |                  |
|               | ical |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **Comments:** |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **SPECIAL     |      |        |        |        |                  |
| ARRANGEMENTS  |      |        |        |        |                  |
| FOR           |      |        |        |        |                  |
| GOVERNMENT    |      |        |        |        |                  |
| EMPLOYEES**   |      |        |        |        |                  |
|               |      |        |        |        |                  |
| NAME(S):      |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| Tire Radial   | Typ  |        |        |        |                  |
|               | ical |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Su   |        |        |        |                  |
|               | bsti |        |        |        |                  |
|               | tute |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
|               | Eco  |        |        |        |                  |
|               | nomy |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+
| **Comments:** |      |        |        |        |                  |
+---------------+------+--------+--------+--------+------------------+

+-----------------------+---------------+----------+------------------+
| **SUBCATEGORY: AUTO   | COST FOR A    | PE       | DESCRIPTION      |
| INSURANCE**           |               | RCENTAGE |                  |
|                       | TWO YEAR OLD  | DISCOUNT |                  |
| **(Typical cost for a | VEHICLE       | WITH A   |                  |
| 25 year old male      |               | SAFE     |                  |
| driver).**            |               | DRIVING  |                  |
|                       |               | RECORD   |                  |
| TAX INCLUDED IN       |               |          |                  |
| REPORTED PRICE?       |               |          |                  |
|                       |               |          |                  |
|  YES  NO  N/A      |               |          |                  |
+-----------------------+---------------+----------+------------------+
| **MOST FREQUENTLY     |               |          |                  |
| USED OUTLET**         |               |          |                  |
|                       |               |          |                  |
| NAME(S):              |               |          |                  |
+-----------------------+---------------+----------+------------------+
| 1\. All Inclusive/All |               |          |                  |
| Risk (Total of 2, 3,  |               |          |                  |
| and 4)                |               |          |                  |
+-----------------------+---------------+----------+------------------+
| 2\. Liability         |               |          |                  |
+-----------------------+---------------+----------+------------------+
| 3\. Collision         |               |          |                  |
+-----------------------+---------------+----------+------------------+
| 4\. Comprehensive     |               |          |                  |
+-----------------------+---------------+----------+------------------+
| Is locally purchased  |               |          |                  |
| liability insurance   |               |          |                  |
| required by           |               |          |                  |
| host-country law?    |               |          |                  |
| Yes  No. If          |               |          |                  |
| employees typically   |               |          |                  |
| purchase additional   |               |          |                  |
| insurance from a U.S. |               |          |                  |
| based on off-shore    |               |          |                  |
| company, explain and  |               |          |                  |
| report the price      |               |          |                  |
| below in the Comments |               |          |                  |
| section.              |               |          |                  |
|                       |               |          |                  |
| Additional required   |               |          |                  |
| insurance not         |               |          |                  |
| reported above:       |               |          |                  |
|                       |               |          |                  |
| Comments:             |               |          |                  |
|                       |               |          |                  |
| Number of years of    |               |          |                  |
| safe driving needed   |               |          |                  |
| to quality for the    |               |          |                  |
| discount:             |               |          |                  |
| \                     |               |          |                  |
| _\_\_\_\_\_\_\_\_\_\_ |               |          |                  |
+-----------------------+---------------+----------+------------------+

PERSONALLY OWNED VEHICLE

  -----------------------------------------------------------------------
  **CATEGORY: HOUSEHOLDHELP**

  CATEGORY TAX RATE:
  -----------------------------------------------------------------------

+-----------------------+---------------+----------+------------------+
| **SUBCATEGORY:        | HOURLY RATE   | FIVE DAY | DESCRIPTION      |
| CHILDCARE**           |               | COST     |                  |
|                       |               |          |                  |
| TAX INCLUDED IN       |               |          |                  |
| REPORTED PRICE?       |               |          |                  |
|                       |               |          |                  |
|  YES  NO  N/A      |               |          |                  |
+-----------------------+---------------+----------+------------------+
| **MOST FREQUENTLY     |               |          |                  |
| USED OUTLET**         |               |          |                  |
|                       |               |          |                  |
| NAME(S):              |               |          |                  |
+-----------------------+---------------+----------+------------------+
| 1\. Childcare,        |               |          |                  |
| Outside the Home      |               |          |                  |
+-----------------------+---------------+----------+------------------+
| 2\. Childcare, In the |               |          |                  |
| Home of the Parent    |               |          |                  |
+-----------------------+---------------+----------+------------------+
| **Comments:**         |               |          |                  |
+-----------------------+---------------+----------+------------------+

+------------+---------+---+------+------+---+----------------------------+
| **SU       |         | H |      | SO   |   | DESCRIPTION                |
| BCATEGORY: |         | O |      | CIAL |   |                            |
| HOUSEHOLD  |         | U |      | SECU |   |                            |
| HELP**     |         | R |      | RITY |   |                            |
|            |         | L |      | TAX  |   |                            |
| TAX        |         | Y |      |      |   |                            |
| INCLUDED   |         | W |      |      |   |                            |
| IN         |         | A |      |      |   |                            |
| REPORTED   |         | G |      |      |   |                            |
| PRICE?     |         | E |      |      |   |                            |
|            |         | S |      |      |   |                            |
|  YES  NO |         |   |      |      |   |                            |
|  N/A      |         |   |      |      |   |                            |
+------------+---------+---+------+------+---+----------------------------+
| **MOST     |         |   |      |      |   |                            |
| FREQUENTLY |         |   |      |      |   |                            |
| USED       |         |   |      |      |   |                            |
| OUTLET**   |         |   |      |      |   |                            |
|            |         |   |      |      |   |                            |
| NAME(S):   |         |   |      |      |   |                            |
+------------+---------+---+------+------+---+----------------------------+
| 1\. Maid   |         |   |      |      |   |                            |
+------------+---------+---+------+------+---+----------------------------+
| 2\. Cook   |         |   |      |      |   |                            |
+------------+---------+---+------+------+---+----------------------------+
| 3\. Day    |         |   |      |      |   |                            |
| Worker     |         |   |      |      |   |                            |
+------------+---------+---+------+------+---+----------------------------+
| According  |         |   |      |      |   |                            |
| to the     |         |   |      |      |   |                            |
| data in    |         |   |      |      |   |                            |
| the most   |         |   |      |      |   |                            |
| recent     |         |   |      |      |   |                            |
| LPQs       |         |   |      |      |   |                            |
| completed  |         |   |      |      |   |                            |
| by         |         |   |      |      |   |                            |
| post/duty  |         |   |      |      |   |                            |
| station    |         |   |      |      |   |                            |
| personnel: |         |   |      |      |   |                            |
+------------+---------+---+------+------+---+----------------------------+
|            | Average |   | H    |      |   |                            |
|            | number  |   | ouse |      |   |                            |
|            | of      |   | hold |      |   |                            |
|            |         |   | Help |      |   |                            |
|            | hours   |   | N    |      |   |                            |
|            | worked  |   | eces |      |   |                            |
|            | per     |   | sary |      |   |                            |
|            | week    |   | for: |      |   |                            |
+------------+---------+---+------+------+---+----------------------------+
| 1\. Maid   |         |   |     |      |  |                            |
|            |         |   | Secu |      | S |                            |
|            |         |   | rity |      | h |                            |
|            |         |   |      |      | o |                            |
|            |         |   |      |      | p |                            |
|            |         |   |      |      | p |                            |
|            |         |   |      |      | i |                            |
|            |         |   |      |      | n |                            |
|            |         |   |      |      | g |                            |
|            |         |   |      |      | F |                            |
|            |         |   |      |      | o |                            |
|            |         |   |      |      | o |                            |
|            |         |   |      |      | d |                            |
|            |         |   |      |      | P |                            |
|            |         |   |      |      | r |                            |
|            |         |   |      |      | e |                            |
|            |         |   |      |      | p |                            |
|            |         |   |      |      | a |                            |
|            |         |   |      |      | r |                            |
|            |         |   |      |      | a |                            |
|            |         |   |      |      | t |                            |
|            |         |   |      |      | i |                            |
|            |         |   |      |      | o |                            |
|            |         |   |      |      | n |                            |
+------------+---------+---+------+------+---+----------------------------+
| 2\. Cook   |         |   |     |      |  |                            |
|            |         |   | Lang |      | E |                            |
|            |         |   | uage |      | x |                            |
|            |         |   | Diff |      | t |                            |
|            |         |   | icul |      | r |                            |
|            |         |   | ties |      | a |                            |
|            |         |   |      |      | c |                            |
|            |         |   |      |      | l |                            |
|            |         |   |      |      | e |                            |
|            |         |   |      |      | a |                            |
|            |         |   |      |      | n |                            |
|            |         |   |      |      | i |                            |
|            |         |   |      |      | n |                            |
|            |         |   |      |      | g |                            |
|            |         |   |      |      | / |                            |
|            |         |   |      |      | l |                            |
|            |         |   |      |      | a |                            |
|            |         |   |      |      | u |                            |
|            |         |   |      |      | n |                            |
|            |         |   |      |      | d |                            |
|            |         |   |      |      | r |                            |
|            |         |   |      |      | y |                            |
|            |         |   |      |      | d |                            |
|            |         |   |      |      | u |                            |
|            |         |   |      |      | e |                            |
|            |         |   |      |      | t |                            |
|            |         |   |      |      | o |                            |
|            |         |   |      |      | c |                            |
|            |         |   |      |      | l |                            |
|            |         |   |      |      | i |                            |
|            |         |   |      |      | m |                            |
|            |         |   |      |      | a |                            |
|            |         |   |      |      | t |                            |
|            |         |   |      |      | e |                            |
+------------+---------+---+------+------+---+----------------------------+
| 3\. Day    |         |   |     |      |   |                            |
| Worker     |         |   | O    |      |   |                            |
|            |         |   | ther |      |   |                            |
|            |         |   | (Pl  |      |   |                            |
|            |         |   | ease |      |   |                            |
|            |         |   | spe  |      |   |                            |
|            |         |   | cify |      |   |                            |
|            |         |   | in   |      |   |                            |
|            |         |   | comm |      |   |                            |
|            |         |   | ents |      |   |                            |
|            |         |   | sect |      |   |                            |
|            |         |   | ion) |      |   |                            |
+------------+---------+---+------+------+---+----------------------------+
| **Jus      |         |   |      |      |   |                            |
| tification |         |   |      |      |   |                            |
| for        |         |   |      |      |   |                            |
| Household  |         |   |      |      |   |                            |
| Help**:    |         |   |      |      |   |                            |
|            |         |   |      |      |   |                            |
| Explain    |         |   |      |      |   |                            |
| fully why  |         |   |      |      |   |                            |
| each type  |         |   |      |      |   |                            |
| of         |         |   |      |      |   |                            |
| domestic   |         |   |      |      |   |                            |
| help       |         |   |      |      |   |                            |
| listed     |         |   |      |      |   |                            |
| above is   |         |   |      |      |   |                            |
| needed at  |         |   |      |      |   |                            |
| the post.  |         |   |      |      |   |                            |
| Follow     |         |   |      |      |   |                            |
| guidance   |         |   |      |      |   |                            |
| on page 37 |         |   |      |      |   |                            |
| of the     |         |   |      |      |   |                            |
| survey     |         |   |      |      |   |                            |
| handbook   |         |   |      |      |   |                            |
| closely.   |         |   |      |      |   |                            |
| Use        |         |   |      |      |   |                            |
| additional |         |   |      |      |   |                            |
| pages as   |         |   |      |      |   |                            |
| necessary. |         |   |      |      |   |                            |
|            |         |   |      |      |   |                            |
| **C        |         |   |      |      |   |                            |
| omments:** |         |   |      |      |   |                            |
+------------+---------+---+------+------+---+----------------------------+

HOUSEHOLD HELP

+------------+----+-------+-------+------+----+-------+------+----+
| **LIVING   |    |       |       |      |    |       |      |    |
| PATTERN    |    |       |       |      |    |       |      |    |
| QUE        |    |       |       |      |    |       |      |    |
| STIONNAIRE |    |       |       |      |    |       |      |    |
| SUMMARY**  |    |       |       |      |    |       |      |    |
|            |    |       |       |      |    |       |      |    |
| **RELATIVE |    |       |       |      |    |       |      |    |
| IMPORTANCE |    |       |       |      |    |       |      |    |
| OF VARIOUS |    |       |       |      |    |       |      |    |
| SOURCES OF |    |       |       |      |    |       |      |    |
| SUPPLY**   |    |       |       |      |    |       |      |    |
|            |    |       |       |      |    |       |      |    |
| **(Columns |    |       |       |      |    |       |      |    |
| must total |    |       |       |      |    |       |      |    |
| 100%       |    |       |       |      |    |       |      |    |
| horiz      |    |       |       |      |    |       |      |    |
| ontally)** |    |       |       |      |    |       |      |    |
+------------+----+-------+-------+------+----+-------+------+----+
| S          | L  | SP    |       | SU   | SU |       |      | T  |
| UBCATETORY | OC | ECIAL |       | PPLY | BS |       |      | OT |
|            | AL | FACIL |       |      | EQ |       |      | AL |
|            |    | ITIES |       | BRO  | UE |       |      |    |
|            | MA |       |       | UGHT | NT |       |      | (  |
|            | RK |       |       |      | P  |       |      | %) |
|            | ET |       |       | TO   | UR |       |      |    |
|            |    |       |       |      | CH |       |      |    |
|            | (  |       |       | CUR  | AS |       |      |    |
|            | %) |       |       | RENT | ES |       |      |    |
|            |    |       |       |      | \* |       |      |    |
|            |    |       |       | LOCA |    |       |      |    |
|            |    |       |       | TION |    |       |      |    |
|            |    |       |       |      |    |       |      |    |
|            |    |       |       | (%)  |    |       |      |    |
+------------+----+-------+-------+------+----+-------+------+----+
|            |    | EM    | MIL   |      | U. | E     | O    |    |
|            |    | BASSY | ITARY |      | S. | XPORT | THER |    |
|            |    |       |       |      | (i |       |      |    |
|            |    | COMMI | COMMI |      | nc | COMP  | LOCA |    |
|            |    | SSARY | SSARY |      | l. | ANIES | TION |    |
|            |    |       |       |      |    |       |      |    |
|            |    | (%)   | EXC   |      | c  | (%)   | (%)  |    |
|            |    |       | HANGE |      | at |       |      |    |
|            |    |       |       |      | al |       |      |    |
|            |    |       | (%)   |      | og |       |      |    |
|            |    |       |       |      | s/ |       |      |    |
|            |    |       |       |      |    |       |      |    |
|            |    |       |       |      | ma |       |      |    |
|            |    |       |       |      | il |       |      |    |
|            |    |       |       |      | -o |       |      |    |
|            |    |       |       |      | rd |       |      |    |
|            |    |       |       |      | er |       |      |    |
|            |    |       |       |      | s) |       |      |    |
|            |    |       |       |      |    |       |      |    |
|            |    |       |       |      | (  |       |      |    |
|            |    |       |       |      | %) |       |      |    |
+------------+----+-------+-------+------+----+-------+------+----+
| Meats      |    |       |       |      |    |       |      | 10 |
|            |    |       |       |      |    |       |      | 0% |
+------------+----+-------+-------+------+----+-------+------+----+
| Seafood    |    |       |       |      |    |       |      | 10 |
|            |    |       |       |      |    |       |      | 0% |
+------------+----+-------+-------+------+----+-------+------+----+
| Poultry    |    |       |       |      |    |       |      | 10 |
|            |    |       |       |      |    |       |      | 0% |
+------------+----+-------+-------+------+----+-------+------+----+
| Dairy      |    |       |       |      |    |       |      | 10 |
| Products   |    |       |       |      |    |       |      | 0% |
+------------+----+-------+-------+------+----+-------+------+----+
| Groceries  |    |       |       |      |    |       |      | 10 |
|            |    |       |       |      |    |       |      | 0% |
+------------+----+-------+-------+------+----+-------+------+----+
| Cigarettes |    |       |       |      |    |       |      | 10 |
|            |    |       |       |      |    |       |      | 0% |
+------------+----+-------+-------+------+----+-------+------+----+
| Alcoholic  |    |       |       |      |    |       |      | 10 |
| Beverages  |    |       |       |      |    |       |      | 0% |
+------------+----+-------+-------+------+----+-------+------+----+
| Fresh      |    |       |       |      |    |       |      | 10 |
| Fruit/     |    |       |       |      |    |       |      | 0% |
| Vegetables |    |       |       |      |    |       |      |    |
+------------+----+-------+-------+------+----+-------+------+----+
| Frozen     |    |       |       |      |    |       |      | 10 |
| Fruit/     |    |       |       |      |    |       |      | 0% |
| Vegetables |    |       |       |      |    |       |      |    |
+------------+----+-------+-------+------+----+-------+------+----+
| Canned     |    |       |       |      |    |       |      | 10 |
| Fruit/     |    |       |       |      |    |       |      | 0% |
| Vegetables |    |       |       |      |    |       |      |    |
+------------+----+-------+-------+------+----+-------+------+----+
| Toiletries |    |       |       |      |    |       |      | 10 |
|            |    |       |       |      |    |       |      | 0% |
+------------+----+-------+-------+------+----+-------+------+----+
| Household  |    |       |       |      |    |       |      | 10 |
| C          |    |       |       |      |    |       |      | 0% |
| onsumables |    |       |       |      |    |       |      |    |
+------------+----+-------+-------+------+----+-------+------+----+
| Medicine   |    |       |       |      |    |       |      | 10 |
|            |    |       |       |      |    |       |      | 0% |
+------------+----+-------+-------+------+----+-------+------+----+
| Au         |    |       |       |      |    |       |      | 10 |
| dio/Visual |    |       |       |      |    |       |      | 0% |
| Supplies   |    |       |       |      |    |       |      |    |
+------------+----+-------+-------+------+----+-------+------+----+
| Ph         |    |       |       |      |    |       |      | 10 |
| otographic |    |       |       |      |    |       |      | 0% |
| Supplies   |    |       |       |      |    |       |      |    |
+------------+----+-------+-------+------+----+-------+------+----+
| Reading    |    |       |       |      |    |       |      | 10 |
| Material   |    |       |       |      |    |       |      | 0% |
+------------+----+-------+-------+------+----+-------+------+----+
| Re         |    |       |       |      |    |       |      | 10 |
| creational |    |       |       |      |    |       |      | 0% |
| Equipment  |    |       |       |      |    |       |      |    |
+------------+----+-------+-------+------+----+-------+------+----+
| Dry        |    |       |       |      |    |       |      | 10 |
| Cleaning   |    |       |       |      |    |       |      | 0% |
+------------+----+-------+-------+------+----+-------+------+----+
| Hair       |    |       |       |      |    |       |      | 10 |
| Services   |    |       |       |      |    |       |      | 0% |
+------------+----+-------+-------+------+----+-------+------+----+
| Doctor     |    |       |       |      |    |       |      | 10 |
|            |    |       |       |      |    |       |      | 0% |
+------------+----+-------+-------+------+----+-------+------+----+
| Dentist    |    |       |       |      |    |       |      | 10 |
|            |    |       |       |      |    |       |      | 0% |
+------------+----+-------+-------+------+----+-------+------+----+
| R          |    |       |       |      |    |       |      | 10 |
| ecretional |    |       |       |      |    |       |      | 0% |
| Activities |    |       |       |      |    |       |      |    |
+------------+----+-------+-------+------+----+-------+------+----+
| Movies     |    |       |       |      |    |       |      | 10 |
|            |    |       |       |      |    |       |      | 0% |
+------------+----+-------+-------+------+----+-------+------+----+
| Performing |    |       |       |      |    |       |      | 10 |
| Arts       |    |       |       |      |    |       |      | 0% |
+------------+----+-------+-------+------+----+-------+------+----+
| Sports     |    |       |       |      |    |       |      | 10 |
| Events     |    |       |       |      |    |       |      | 0% |
+------------+----+-------+-------+------+----+-------+------+----+
| Auto       |    |       |       |      |    |       |      | 10 |
| M          |    |       |       |      |    |       |      | 0% |
| aintenance |    |       |       |      |    |       |      |    |
+------------+----+-------+-------+------+----+-------+------+----+
| Gasoline   |    |       |       |      |    |       |      | 10 |
|            |    |       |       |      |    |       |      | 0% |
+------------+----+-------+-------+------+----+-------+------+----+
| Auto Tires |    |       |       |      |    |       |      | 10 |
|            |    |       |       |      |    |       |      | 0% |
+------------+----+-------+-------+------+----+-------+------+----+
| \*\*       |    |       |       |      |    |       |      |    |
| SUBSEQUENT |    |       |       |      |    |       |      |    |
| PURCHASES  |    |       |       |      |    |       |      |    |
| represent  |    |       |       |      |    |       |      |    |
| those      |    |       |       |      |    |       |      |    |
| items not  |    |       |       |      |    |       |      |    |
| brought in |    |       |       |      |    |       |      |    |
| at         |    |       |       |      |    |       |      |    |
| Government |    |       |       |      |    |       |      |    |
| expense.   |    |       |       |      |    |       |      |    |
| \"U.S.\"   |    |       |       |      |    |       |      |    |
| includes   |    |       |       |      |    |       |      |    |
| items      |    |       |       |      |    |       |      |    |
| ma         |    |       |       |      |    |       |      |    |
| il-ordered |    |       |       |      |    |       |      |    |
| from       |    |       |       |      |    |       |      |    |
| retail     |    |       |       |      |    |       |      |    |
| outlets    |    |       |       |      |    |       |      |    |
|            |    |       |       |      |    |       |      |    |
| in the     |    |       |       |      |    |       |      |    |
| U.S. as    |    |       |       |      |    |       |      |    |
| well as    |    |       |       |      |    |       |      |    |
| all        |    |       |       |      |    |       |      |    |
| catalog    |    |       |       |      |    |       |      |    |
| orders.    |    |       |       |      |    |       |      |    |
| \"EXPORT   |    |       |       |      |    |       |      |    |
| C          |    |       |       |      |    |       |      |    |
| OMPANIES\" |    |       |       |      |    |       |      |    |
| refer to   |    |       |       |      |    |       |      |    |
| sources    |    |       |       |      |    |       |      |    |
| such as    |    |       |       |      |    |       |      |    |
| Emborg and |    |       |       |      |    |       |      |    |
| Peter      |    |       |       |      |    |       |      |    |
| Justesen,  |    |       |       |      |    |       |      |    |
| etc.       |    |       |       |      |    |       |      |    |
| \"OTHER\"  |    |       |       |      |    |       |      |    |
| refers to  |    |       |       |      |    |       |      |    |
|            |    |       |       |      |    |       |      |    |
| another    |    |       |       |      |    |       |      |    |
| post or    |    |       |       |      |    |       |      |    |
| foreign    |    |       |       |      |    |       |      |    |
| location.  |    |       |       |      |    |       |      |    |
|            |    |       |       |      |    |       |      |    |
| Date of    |    |       |       |      |    |       |      |    |
| most       |    |       |       |      |    |       |      |    |
| recent     |    |       |       |      |    |       |      |    |
| employee   |    |       |       |      |    |       |      |    |
| living     |    |       |       |      |    |       |      |    |
| pattern    |    |       |       |      |    |       |      |    |
| que        |    |       |       |      |    |       |      |    |
| stionnaire |    |       |       |      |    |       |      |    |
| survey     |    |       |       |      |    |       |      |    |
| \          |    |       |       |      |    |       |      |    |
| _\_\_\_\_. |    |       |       |      |    |       |      |    |
| Number of  |    |       |       |      |    |       |      |    |
| employees  |    |       |       |      |    |       |      |    |
| par        |    |       |       |      |    |       |      |    |
| ticipating |    |       |       |      |    |       |      |    |
| in         |    |       |       |      |    |       |      |    |
| sur        |    |       |       |      |    |       |      |    |
| vey\_\_\_\ |    |       |       |      |    |       |      |    |
| _\_\_\_\_. |    |       |       |      |    |       |      |    |
|            |    |       |       |      |    |       |      |    |
| Note: If   |    |       |       |      |    |       |      |    |
| living     |    |       |       |      |    |       |      |    |
| patterns   |    |       |       |      |    |       |      |    |
| for        |    |       |       |      |    |       |      |    |
| civilians  |    |       |       |      |    |       |      |    |
| and        |    |       |       |      |    |       |      |    |
| Uniformed  |    |       |       |      |    |       |      |    |
| Service    |    |       |       |      |    |       |      |    |
| members    |    |       |       |      |    |       |      |    |
| differ     |    |       |       |      |    |       |      |    |
| subs       |    |       |       |      |    |       |      |    |
| tantially, |    |       |       |      |    |       |      |    |
| prepare    |    |       |       |      |    |       |      |    |
| separate   |    |       |       |      |    |       |      |    |
| pages 39   |    |       |       |      |    |       |      |    |
| for both   |    |       |       |      |    |       |      |    |
| groups and |    |       |       |      |    |       |      |    |
| submit     |    |       |       |      |    |       |      |    |
| both pages |    |       |       |      |    |       |      |    |
| to the     |    |       |       |      |    |       |      |    |
| Department |    |       |       |      |    |       |      |    |
| of State   |    |       |       |      |    |       |      |    |
| Office of  |    |       |       |      |    |       |      |    |
| Allowances |    |       |       |      |    |       |      |    |
| for        |    |       |       |      |    |       |      |    |
| analysis.  |    |       |       |      |    |       |      |    |
|            |    |       |       |      |    |       |      |    |
| Comments:  |    |       |       |      |    |       |      |    |
+------------+----+-------+-------+------+----+-------+------+----+

RELATIVE IMPORTANCE OF VARIOUS SOURCES OF SUPPLY

+--------------+-------+-----+--------+---------+----+--------------+
| **LIVING     |       |     |        |         |    |              |
| PATTERN      |       |     |        |         |    |              |
| Q            |       |     |        |         |    |              |
| UESTIONNAIRE |       |     |        |         |    |              |
| SUMMARY**    |       |     |        |         |    |              |
|              |       |     |        |         |    |              |
| **RELATIVE   |       |     |        |         |    |              |
| USE OF       |       |     |        |         |    |              |
| COMMODITIES  |       |     |        |         |    |              |
| AND          |       |     |        |         |    |              |
| SERVICES**   |       |     |        |         |    |              |
+--------------+-------+-----+--------+---------+----+--------------+
| 1\. As       |       |     |        |         |    |              |
| determined   |       |     |        |         |    |              |
| by the most  |       |     |        |         |    |              |
| recent LPQs, |       |     |        |         |    |              |
| approximate  |       |     |        |         |    |              |
| the          |       |     |        |         |    |              |
| proportion   |       |     |        |         |    |              |
| of each      |       |     |        |         |    |              |
| specified    |       |     |        |         |    |              |
| type of food |       |     |        |         |    |              |
| used by      |       |     |        |         |    |              |
| Americans at |       |     |        |         |    |              |
| the post,    |       |     |        |         |    |              |
|              |       |     |        |         |    |              |
| based on     |       |     |        |         |    |              |
| volume only, |       |     |        |         |    |              |
| for meals    |       |     |        |         |    |              |
| eaten at     |       |     |        |         |    |              |
| home.        |       |     |        |         |    |              |
+--------------+-------+-----+--------+---------+----+--------------+
| [FRUITS]     | [VEG  |     |        | [MIL    |    | [MEATS/FISH] |
| {.underline} | ETABL |     |        | K]{.und |    | {.underline} |
|              | ES]{. |     |        | erline} |    |              |
| Fresh        | under |     |        |         |    | Beef         |
| \_\          | line} |     |        | Milk,   |    | \_\_\_\      |
| _\_\_\_\_\_% |       |     |        | Fr      |    | _\_\_\_\_\_% |
|              | V     |     |        | esh/UHT |    |              |
| Canned       | egeta |     |        | \       |    | Pork         |
| \            | bles, |     |        | _\_\_\_ |    | \_\_\_\      |
| _\_\_\_\_\_% | Fresh |     |        | \_\_\_% |    | _\_\_\_\_\_% |
|              | \_\_  |     |        |         |    |              |
| **100%**     | \_\_\ |     |        | Milk,   |    | Lamb         |
|              | _\_\_ |     |        | Dried   |    | \_\_\_\      |
|              | \_\_% |     |        | \       |    | _\_\_\_\_\_% |
|              |       |     |        | _\_\_\_ |    |              |
|              | V     |     |        | \_\_\_% |    | Seafood      |
|              | egeta |     |        |         |    | \_\_\        |
|              | bles, |     |        | *       |    | _\_\_\_\_\_% |
|              | C     |     |        | *100%** |    |              |
|              | anned |     |        |         |    | Poultry      |
|              | \_    |     |        |         |    | \_\_\        |
|              | \_\_\ |     |        |         |    | _\_\_\_\_\_% |
|              | _\_\_ |     |        |         |    |              |
|              | \_\_% |     |        |         |    | **100%**     |
|              |       |     |        |         |    |              |
|              | V     |     |        |         |    |              |
|              | egeta |     |        |         |    |              |
|              | bles, |     |        |         |    |              |
|              | F     |     |        |         |    |              |
|              | rozen |     |        |         |    |              |
|              | \_\_  |     |        |         |    |              |
|              | \_\_\ |     |        |         |    |              |
|              | _\_\_ |     |        |         |    |              |
|              | \_\_% |     |        |         |    |              |
|              |       |     |        |         |    |              |
|              | **1   |     |        |         |    |              |
|              | 00%** |     |        |         |    |              |
+--------------+-------+-----+--------+---------+----+--------------+
| 2\. As       |       |     |        | 3\.     |    |              |
| determined   |       |     |        | Average |    |              |
| by the most  |       |     |        | usage   |    |              |
| recent LPQs, |       |     |        | of the  |    |              |
| to what      |       |     |        | methods |    |              |
| extent are   |       |     |        | of      |    |              |
| the          |       |     |        | t       |    |              |
| following    |       |     |        | ranspor |    |              |
|              |       |     |        | tation, |    |              |
| meal         |       |     |        | as      |    |              |
| facilities   |       |     |        |         |    |              |
| used based   |       |     |        | det     |    |              |
| on family    |       |     |        | ermined |    |              |
| use:         |       |     |        | by the  |    |              |
|              |       |     |        | most    |    |              |
|              |       |     |        | recent  |    |              |
|              |       |     |        | LPQs:   |    |              |
+--------------+-------+-----+--------+---------+----+--------------+
|              | Brea  | Lu  | Dinner | Per     |    |              |
|              | kfast | nch |        | sonally |    |              |
|              |       |     |        | Owned   |    |              |
|              |       |     |        | Vehicle |    |              |
|              |       |     |        | \_\_\_\ |    |              |
|              |       |     |        | _\_\_\_ |    |              |
|              |       |     |        | \_\_\_% |    |              |
+--------------+-------+-----+--------+---------+----+--------------+
| Local        | \_\_\ | \   | \_\    | Gov     |    |              |
| Restaurants  | _\_\_ | _\_ | _\_\_\ | ernment |    |              |
|              | \_\_% | \_\ | _\_\_% | Transpo |    |              |
|              |       | _\_ |        | rtation |    |              |
|              |       | \_% |        | \_\_\_\ |    |              |
|              |       |     |        | _\_\_\_ |    |              |
|              |       |     |        | \_\_\_% |    |              |
+--------------+-------+-----+--------+---------+----+--------------+
| Post         | \_\_\ | \   | \_\    | Taxi    |    |              |
| Restaurant   | _\_\_ | _\_ | _\_\_\ | \_\_\_\ |    |              |
|              | \_\_% | \_\ | _\_\_% | _\_\_\_ |    |              |
|              |       | _\_ |        | \_\_\_% |    |              |
|              |       | \_% |        |         |    |              |
+--------------+-------+-----+--------+---------+----+--------------+
| Military     | \_\_\ | \   | \_\    | Mu      |    |              |
| Restaurant   | _\_\_ | _\_ | _\_\_\ | nicipal |    |              |
|              | \_\_% | \_\ | _\_\_% | Bus     |    |              |
|              |       | _\_ |        | \_\_\_\ |    |              |
|              |       | \_% |        | _\_\_\_ |    |              |
|              |       |     |        | \_\_\_% |    |              |
+--------------+-------+-----+--------+---------+----+--------------+
| Home         | \_\_\ | \   | \_\    | S       |    |              |
|              | _\_\_ | _\_ | _\_\_\ | ubway/C |    |              |
|              | \_\_% | \_\ | _\_\_% | ommuter |    |              |
|              |       | _\_ |        | Train   |    |              |
|              |       | \_% |        | \_\_\_\ |    |              |
|              |       |     |        | _\_\_\_ |    |              |
|              |       |     |        | \_\_\_% |    |              |
+--------------+-------+-----+--------+---------+----+--------------+
|              | 100%  | 1   | 100%   | 100%    |    |              |
|              |       | 00% |        |         |    |              |
+--------------+-------+-----+--------+---------+----+--------------+
| 4\. Number   |       |     |        |         |    |              |
| of U. S. G.  |       |     |        |         |    |              |
| employees at |       |     |        |         |    |              |
| post:        |       |     |        |         |    |              |
| Civilian     |       |     |        |         |    |              |
| \_\_\_\_     |       |     |        |         |    |              |
| \_\_\_\_\_\_ |       |     |        |         |    |              |
| Uniformed    |       |     |        |         |    |              |
| Military     |       |     |        |         |    |              |
| \_\_\_\_     |       |     |        |         |    |              |
| \_\_\_\_\_\_ |       |     |        |         |    |              |
|              |       |     |        |         |    |              |
| Number of    |       |     |        |         |    |              |
| U.S.G.       |       |     |        |         |    |              |
| employees    |       |     |        |         |    |              |
| provided     |       |     |        |         |    |              |
| major        |       |     |        |         |    |              |
| household    |       |     |        |         |    |              |
| furniture by |       |     |        |         |    |              |
| landlord or  |       |     |        |         |    |              |
| government:  |       |     |        |         |    |              |
| Civilian     |       |     |        |         |    |              |
| \_\_\_\_\_\_ |       |     |        |         |    |              |
| Uniformed    |       |     |        |         |    |              |
| Military     |       |     |        |         |    |              |
| \_\_\_\_\_   |       |     |        |         |    |              |
|              |       |     |        |         |    |              |
| Number of    |       |     |        |         |    |              |
| U.S.G.       |       |     |        |         |    |              |
| employees    |       |     |        |         |    |              |
| provided     |       |     |        |         |    |              |
| major        |       |     |        |         |    |              |
| appliances   |       |     |        |         |    |              |
| by landlord  |       |     |        |         |    |              |
| or           |       |     |        |         |    |              |
| government:  |       |     |        |         |    |              |
| Civilian     |       |     |        |         |    |              |
| \_\_\_\_     |       |     |        |         |    |              |
| \_\_\_\_\_\_ |       |     |        |         |    |              |
| Uniformed    |       |     |        |         |    |              |
| Military     |       |     |        |         |    |              |
| \_\_         |       |     |        |         |    |              |
| \_\_\_\_\_\_ |       |     |        |         |    |              |
+--------------+-------+-----+--------+---------+----+--------------+
| 5\. If any   |       |     |        |         |    |              |
| commissary   |       |     |        |         |    |              |
| and exchange |       |     |        |         |    |              |
| facilities   |       |     |        |         |    |              |
| are listed   |       |     |        |         |    |              |
| under        |       |     |        |         |    |              |
| \"SPECIAL    |       |     |        |         |    |              |
| FACILITIES\" |       |     |        |         |    |              |
| on page 39,  |       |     |        |         |    |              |
| describe the |       |     |        |         |    |              |
| type of      |       |     |        |         |    |              |
| facility,    |       |     |        |         |    |              |
| its distance |       |     |        |         |    |              |
| from the     |       |     |        |         |    |              |
| post, and    |       |     |        |         |    |              |
| the typical  |       |     |        |         |    |              |
| expenses     |       |     |        |         |    |              |
| incurred in  |       |     |        |         |    |              |
| using that   |       |     |        |         |    |              |
| facility     |       |     |        |         |    |              |
| (i.e. the    |       |     |        |         |    |              |
| means of     |       |     |        |         |    |              |
| obtaining    |       |     |        |         |    |              |
| goods and    |       |     |        |         |    |              |
| services,    |       |     |        |         |    |              |
| road         |       |     |        |         |    |              |
| mileage,     |       |     |        |         |    |              |
| road and     |       |     |        |         |    |              |
| bridge       |       |     |        |         |    |              |
| tolls, etc.) |       |     |        |         |    |              |
+--------------+-------+-----+--------+---------+----+--------------+
| Name of      |       | One |        |         | O  |              |
| commissa     |       | way |        |         | ne |              |
| ry/exchange: |       | dis |        |         | w  |              |
|              |       | tra |        |         | ay |              |
|              |       | nce |        |         | ro |              |
|              |       | f   |        |         | ad |              |
|              |       | rom |        |         | to |              |
|              |       | p   |        |         | ll |              |
|              |       | ost |        |         | s: |              |
|              |       | of  |        |         |    |              |
|              |       | as  |        |         |    |              |
|              |       | sig |        |         |    |              |
|              |       | nme |        |         |    |              |
|              |       | nt: |        |         |    |              |
+--------------+-------+-----+--------+---------+----+--------------+
| 6\. Report   |       |     |        |         |    |              |
| the names of |       |     |        |         |    |              |
| export       |       |     |        |         |    |              |
| companies    |       |     |        |         |    |              |
| and \"other  |       |     |        |         |    |              |
| location\"   |       |     |        |         |    |              |
| commonly     |       |     |        |         |    |              |
| used for the |       |     |        |         |    |              |
| purchases    |       |     |        |         |    |              |
| reported on  |       |     |        |         |    |              |
| page 39:     |       |     |        |         |    |              |
|              |       |     |        |         |    |              |
| Export       |       |     |        |         |    |              |
| Company Name |       |     |        |         |    |              |
| and          |       |     |        |         |    |              |
| Location:    |       |     |        |         |    |              |
|              |       |     |        |         |    |              |
| City or      |       |     |        |         |    |              |
| country of   |       |     |        |         |    |              |
| \"Other      |       |     |        |         |    |              |
| Location\":  |       |     |        |         |    |              |
+--------------+-------+-----+--------+---------+----+--------------+
| Note: If     |       |     |        |         |    |              |
| living       |       |     |        |         |    |              |
| patterns for |       |     |        |         |    |              |
| civilians    |       |     |        |         |    |              |
| and          |       |     |        |         |    |              |
| Uniformed    |       |     |        |         |    |              |
| Service      |       |     |        |         |    |              |
| members      |       |     |        |         |    |              |
| differ       |       |     |        |         |    |              |
| su           |       |     |        |         |    |              |
| bstantially, |       |     |        |         |    |              |
| prepare      |       |     |        |         |    |              |
| separate     |       |     |        |         |    |              |
| pages 40 for |       |     |        |         |    |              |
| each group   |       |     |        |         |    |              |
| and submit   |       |     |        |         |    |              |
| both pages   |       |     |        |         |    |              |
| to the       |       |     |        |         |    |              |
| Department   |       |     |        |         |    |              |
| of State     |       |     |        |         |    |              |
| Office of    |       |     |        |         |    |              |
| Allowances   |       |     |        |         |    |              |
| for          |       |     |        |         |    |              |
| analysis.    |       |     |        |         |    |              |
+--------------+-------+-----+--------+---------+----+--------------+

RELATIVE USE OF COMMODITIES AND SERVICES

+----------------------------+-------+--------------------------------+
| Interagency Report Control |       |                                |
| No. 1168-DOS-AN            |       |                                |
|                            |       |                                |
| **UNITED STATES DEPARTMENT |       |                                |
| OF STATE**                 |       |                                |
|                            |       |                                |
| Hotel and Restaurant       |       |                                |
| Report (DSP-23W)           |       |                                |
|                            |       |                                |
| Survey Location:           |       |                                |
| \_\_\_\_\_\_\_\_\_         |       |                                |
| \_\_\_\_\_\_\_\_\_\_\_\_\_ |       |                                |
+----------------------------+-------+--------------------------------+
|                            | Post  |                                |
+----------------------------+-------+--------------------------------+
|                            | U.S.  |                                |
|                            | A     |                                |
|                            | gency |                                |
+----------------------------+-------+--------------------------------+
|                            | Date  |                                |
|                            | of    |                                |
|                            | S     |                                |
|                            | urvey |                                |
|                            | (Date |                                |
|                            | most  |                                |
|                            | data  |                                |
|                            | re    |                                |
|                            | colle |                                |
|                            | cted) |                                |
+----------------------------+-------+--------------------------------+
| INSTRUCTIONS               |       |                                |
|                            |       |                                |
| \(a\) This is the Hotel    |       |                                |
| and Restaurant Report      |       |                                |
| (Form DSP-23W) of the      |       |                                |
| complete Retail Price      |       |                                |
| Schedule (Form DSP-23Y)    |       |                                |
| and is to be submitted by  |       |                                |
|                            |       |                                |
| > civilian Federal         |       |                                |
| > agencies in accordance   |       |                                |
| > with Sections 070, 920,  |       |                                |
| > and 950 of the           |       |                                |
| > Department of State      |       |                                |
| > Standardized Regulations |       |                                |
| > (DSSR). Reports          |       |                                |
| > submitted by Uniformed   |       |                                |
| > Service members must     |       |                                |
| > follow procedures        |       |                                |
| > provided in Appendix M   |       |                                |
| > of the Joint Federal     |       |                                |
| > Travel Regulations.      |       |                                |
|                            |       |                                |
| \(b\) The prices reported  |       |                                |
| on the following pages are |       |                                |
| used in determining        |       |                                |
| maximum travel per diem    |       |                                |
| allowances. Should there   |       |                                |
| be absolutely no hotel or  |       |                                |
|                            |       |                                |
| > restaurant facilities    |       |                                |
| > (including hostels and   |       |                                |
| > guest houses), this      |       |                                |
| > section should contain a |       |                                |
| > precise statement as to  |       |                                |
| > what arrangements are    |       |                                |
| > made for transients.     |       |                                |
|                            |       |                                |
| c\) RESTAURANTS AND FAST   |       |                                |
| FOOD FACILITIES            |       |                                |
|                            |       |                                |
| > The restaurants used in  |       |                                |
| > this survey must         |       |                                |
| > represent those          |       |                                |
| > facilities most          |       |                                |
| > frequently used by       |       |                                |
| > typical Federal          |       |                                |
| > travelers and employees  |       |                                |
| > assigned abroad. For     |       |                                |
| > posts submitting the     |       |                                |
| > full Retail Price        |       |                                |
| > Schedule (Form DSP-23Y), |       |                                |
| > the selection of         |       |                                |
| > restaurants must be      |       |                                |
| > based on the meal        |       |                                |
| > facilities reported as   |       |                                |
| > most frequently used by  |       |                                |
| > employees in the last    |       |                                |
| > living pattern           |       |                                |
| > questionnaire survey.    |       |                                |
| >                          |       |                                |
| > Select fast food outlets |       |                                |
| > typically used by        |       |                                |
| > employees seeking a      |       |                                |
| > light meal as an         |       |                                |
| > alternative to           |       |                                |
| > restaurant dining. If    |       |                                |
| > there are no fast food   |       |                                |
| > outlets at post, a       |       |                                |
| > coffee shop or similar   |       |                                |
| > facility should be used  |       |                                |
| > as a substitute outlet.  |       |                                |
|                            |       |                                |
| \(d\) HOTELS               |       |                                |
|                            |       |                                |
| > Only moderately priced   |       |                                |
| > hotels most frequently   |       |                                |
| > used by Federal          |       |                                |
| > employees should be      |       |                                |
| > priced. If the hotel has |       |                                |
| > no single rooms with     |       |                                |
| > private bath, report and |       |                                |
| > describe the type of     |       |                                |
| > rooms available.         |       |                                |
| > Carefully note whether   |       |                                |
| > rates reported are for   |       |                                |
| > single occupancy of a    |       |                                |
| > double room. (If         |       |                                |
| > lower-priced single      |       |                                |
| > rooms are available at a |       |                                |
| > comparable hotel, this   |       |                                |
| > facility should also be  |       |                                |
| > included in this         |       |                                |
| > report.)                 |       |                                |
| >                          |       |                                |
| > Typical Price - The      |       |                                |
| > \"typical\" price level  |       |                                |
| > should be the basic rate |       |                                |
| > for rooms most often     |       |                                |
| > occupied by Federal      |       |                                |
| > civilian and military    |       |                                |
| > travelers. If this is    |       |                                |
| > not known, report the    |       |                                |
| > medium price level.      |       |                                |
| >                          |       |                                |
| > Substitute Price - The   |       |                                |
| > \"substitute\" price     |       |                                |
| > level should represent   |       |                                |
| > the second most used     |       |                                |
| > price level.             |       |                                |
|                            |       |                                |
| \(e\) Provide menus and    |       |                                |
| hotel tariff lists when    |       |                                |
| possible.                  |       |                                |
|                            |       |                                |
| \(f\) Report all prices in |       |                                |
| the currency required by   |       |                                |
| the facility. Any use of   |       |                                |
| U.S. dollars in local      |       |                                |
| hotels and meal facilities |       |                                |
| must be fully explained.   |       |                                |
+----------------------------+-------+--------------------------------+
| CURRENCY AND HOTELS        |       |                                |
|                            |       |                                |
| \(1\) List prevailing      |       |                                |
| currency exchange rates    |       |                                |
| available to Federal       |       |                                |
| Government personnel       |       |                                |
| (civilian and military)    |       |                                |
| and describe primary       |       |                                |
| source                     |       |                                |
|                            |       |                                |
| (i.e., local banks, USDO,  |       |                                |
| etc.)                      |       |                                |
|                            |       |                                |
| \(2\) Briefly discuss      |       |                                |
| changes in the             |       |                                |
| availability of hotels and |       |                                |
| price levels since the     |       |                                |
| previous Hotel and         |       |                                |
| Restaurant Report.         |       |                                |
+----------------------------+-------+--------------------------------+
| I certify that this report |       |                                |
| is accurate, complete,     |       |                                |
| current, and in compliance |       |                                |
| with the DSSR and the      |       |                                |
| above instructions         |       |                                |
+----------------------------+-------+--------------------------------+
| >  No employees are       |       | \_\_\_\_\_\_                   |
| > currently assigned to    |       | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
| > this survey location.    |       | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
| > However, the selected    |       |                                |
| > facilities fairly        |       | Signature of Certifying        |
| > represent reasonably     |       | Official                       |
| > priced hotels and        |       |                                |
| > restaurants suitable for |       | \_\_\_\_\_\_                   |
| > employees.               |       | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                            |       | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                            |       |                                |
|                            |       | Name (Prince or Typed)         |
|                            |       |                                |
|                            |       | \_\_\_\_\_\_\_                 |
|                            |       | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                            |       | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                            |       |                                |
|                            |       | Title                          |
+----------------------------+-------+--------------------------------+

Form DSP-23Y Revised 10/98 HOTEL AND RESTAURANT REPORT (FORM DSP-23W)

<table>
<colgroup>
<col style="width: 21%" />
<col style="width: 5%" />
<col style="width: 5%" />
<col style="width: 2%" />
<col style="width: 5%" />
<col style="width: 3%" />
<col style="width: 2%" />
<col style="width: 5%" />
<col style="width: 4%" />
<col style="width: 0%" />
<col style="width: 5%" />
<col style="width: 0%" />
<col style="width: 2%" />
<col style="width: 4%" />
<col style="width: 0%" />
<col style="width: 4%" />
<col style="width: 0%" />
<col style="width: 4%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 4%" />
<col style="width: 3%" />
<col style="width: 4%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="23"><p><strong>TYPICAL RESTAURANT PRICES</strong></p>
<p><strong>(NECESSARY SUBSTITUTES MUST BE SPECIFIED)</strong></p></td>
</tr>
<tr class="even">
<td rowspan="2"><p>BREAKFAST:</p>
<p>RESTAURANT</p>
<p>NAME</p></td>
<td rowspan="2">FRUIT OR JUICE</td>
<td colspan="2" rowspan="2"><p>BOWL</p>
<p>OF</p>
<p>CEREAL</p></td>
<td colspan="2" rowspan="2"><p>BACON</p>
<p>AND</p>
<p>EGGS (2)</p></td>
<td colspan="2" rowspan="2"><p>TOAST</p>
<p>AND</p>
<p>BUTTER</p></td>
<td colspan="3" rowspan="2"><p>COFFEE</p>
<p>OR</p>
<p>TEA</p></td>
<td colspan="4">TAXES*</td>
<td colspan="3"><p>SERVICE CHG.</p>
<p>OR TIP*</p></td>
<td colspan="5" rowspan="6">Comments:</td>
</tr>
<tr class="odd">
<td colspan="2">%</td>
<td colspan="2">FLAT</td>
<td>%</td>
<td colspan="2">FLAT</td>
</tr>
<tr class="even">
<td>1. Most used restaurant</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td>2. Second most used restaurant</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td>3. Fast food outlet</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td>4. Military facility</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td>5. Post facility</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td colspan="5"><p>PRICES IN LOCAL CURRENCY?</p>
<p> Yes  No</p></td>
</tr>
<tr class="odd">
<td rowspan="6"><p>LUNCH:</p>
<p>RESTAURANT</p>
<p>NAME</p></td>
<td rowspan="6">SOUP OR JUICE</td>
<td colspan="5">MEDIUM-PRICED MEATS</td>
<td colspan="7">(IF NOT INCL. IN MEAT PRICE)</td>
<td colspan="3" rowspan="6"><p>PIE</p>
<p>OR</p>
<p>CAKE</p></td>
<td colspan="2" rowspan="6"><p>COFFEE</p>
<p>OR</p>
<p>TEA</p></td>
<td colspan="2" rowspan="5">Taxes*</td>
<td colspan="2" rowspan="5"><p>Service Chg.</p>
<p>or</p>
<p>Tip*</p></td>
</tr>
<tr class="even">
<td rowspan="5">BEEF</td>
<td colspan="2" rowspan="5">CHICKEN</td>
<td colspan="2" rowspan="5">FISH</td>
<td colspan="2" rowspan="5"><p>TWO TYPICAL</p>
<p>VEGETABLES</p></td>
<td colspan="3" rowspan="5"><p>SMALL</p>
<p>SALAD</p></td>
<td colspan="2" rowspan="5"><p>BREAD &amp;</p>
<p>BUTTER</p></td>
</tr>
<tr class="odd">
</tr>
<tr class="even">
</tr>
<tr class="odd">
</tr>
<tr class="even">
<td>%</td>
<td>Flat</td>
<td>%</td>
<td>Flat</td>
</tr>
<tr class="odd">
<td>6. Most used restaurant</td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>7. Second most used restaurant</td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>8. Third most used restaurant</td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>9. Military (club)</td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>10. Post facility</td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td rowspan="6"><p>DINNER:</p>
<p>RESTAURANT</p>
<p>NAME</p></td>
<td rowspan="6">SOUP OR JUICE</td>
<td colspan="5">MEDIUM-PRICED MEATS</td>
<td colspan="7">(IF NOT INCL. IN MEAT PRICE)</td>
<td colspan="3" rowspan="6"><p>PIE</p>
<p>OR</p>
<p>CAKE</p></td>
<td colspan="2" rowspan="6"><p>COFFEE</p>
<p>OR</p>
<p>TEA</p></td>
<td colspan="2" rowspan="5">Taxes*</td>
<td colspan="2" rowspan="5"><p>Service Chg.</p>
<p>or</p>
<p>Tip*</p></td>
</tr>
<tr class="odd">
<td rowspan="5">BEEF</td>
<td colspan="2" rowspan="5">CHICKEN</td>
<td colspan="2" rowspan="5">FISH</td>
<td colspan="2" rowspan="5"><p>TWO TYPICAL</p>
<p>VEGETABLES</p></td>
<td colspan="3" rowspan="5"><p>SMALL</p>
<p>SALAD</p></td>
<td colspan="2" rowspan="5"><p>BREAD &amp;</p>
<p>BUTTER</p></td>
</tr>
<tr class="even">
</tr>
<tr class="odd">
</tr>
<tr class="even">
</tr>
<tr class="odd">
<td>%</td>
<td>Flat</td>
<td>%</td>
<td>Flat</td>
</tr>
<tr class="even">
<td>11. Most used restaurant</td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>12. Second most used restaurant</td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>13. Third most used restaurant</td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>14. Military (club)</td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>15. Post facility</td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="18">TYPICAL FAST FOOD EATING FACILITIES (Substitute items
must be specified)</td>
<td colspan="5"></td>
</tr>
<tr class="even">
<td rowspan="2"><p>FAST FOOD FACILITY</p>
<p>NAME</p></td>
<td colspan="3">HAMBURGER</td>
<td colspan="4">FRIED CHICKED</td>
<td colspan="3">FRENCH FRIES</td>
<td colspan="4">COLA DRINK</td>
<td colspan="3">TAXES*</td>
<td colspan="5" rowspan="7">Comments:</td>
</tr>
<tr class="odd">
<td>Med.</td>
<td colspan="2">Large</td>
<td colspan="2">2 pieces</td>
<td colspan="2">3 pieces</td>
<td colspan="2">Med</td>
<td>Large</td>
<td colspan="4">MEDIUM</td>
<td>%</td>
<td colspan="2">FLAT</td>
</tr>
<tr class="even">
<td>16. Most used restaurant</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td colspan="4"></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td>17. Second most used restaurant</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td colspan="4"></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td>18. Third most used</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td colspan="4"></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td>19. Military facility</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td colspan="4"></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td>20. Post snack bar</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td colspan="4"></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="23">*If the reported prices include taxes, service charges,
or tips, the corresponding column must be left blank.</td>
</tr>
<tr class="even">
<td colspan="23"><p>Any reporting of hotel restaurants for meals must be
required by local conditions and fully explained below. Any reported
service charges or tips must be mandatory or customary in the locality.
Inlcude names of all local restuarants. Use additional page as
necessary.</p>
<p>Note: The instructions on page 41 &amp; in Section 950 of the
Department of State's Standardized Regulations (DSSR) must be followed
in completing this page.</p></td>
</tr>
</tbody>
</table>

RESTAURANT PRICES

<table>
<colgroup>
<col style="width: 16%" />
<col style="width: 4%" />
<col style="width: 8%" />
<col style="width: 5%" />
<col style="width: 5%" />
<col style="width: 8%" />
<col style="width: 12%" />
<col style="width: 4%" />
<col style="width: 5%" />
<col style="width: 4%" />
<col style="width: 5%" />
<col style="width: 17%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="12"><strong>HOTELS</strong></td>
</tr>
<tr class="even">
<td colspan="2" rowspan="3">HOTEL NAME AND LOCATION</td>
<td colspan="5">DAILY SINGLE ROOM RATE</td>
<td colspan="4">REQUIRED</td>
<td rowspan="3"><p>EXPLAIN ANY</p>
<p>DISCOUNTS TO ALL</p>
<p>USG PERSONNEL</p></td>
</tr>
<tr class="odd">
<td colspan="3">LOW SEASON</td>
<td colspan="2">HIGH SEASON*</td>
<td colspan="2">TAXES</td>
<td colspan="2">SERVICE CHG</td>
</tr>
<tr class="even">
<td>TYPICAL</td>
<td colspan="2">SUBSTITUTE</td>
<td>TYPICAL</td>
<td>SUBSTITUTE</td>
<td>%</td>
<td>FLAT</td>
<td>%</td>
<td>FLAT</td>
</tr>
<tr class="odd">
<td colspan="11"><p>Most frequently used hotel:</p>
<p>Location:</p></td>
<td rowspan="5">COMMENTS</td>
</tr>
<tr class="even">
<td colspan="2">1. Without Meals</td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2">2. With breakfast</td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="2">3. With breakfast and dinner</td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2">4. With all meals</td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="10"><p>The reported rates include:  Taxes  Service
Charges  Discounts for All USG Personnel</p>
<p>Reported in local currency?  Yes  No</p></td>
<td colspan="2"><p># of rooms in hotel:</p>
<p># of reservations from post log</p></td>
</tr>
<tr class="odd">
<td colspan="11"><p>Second most used hotel:</p>
<p>Location:</p></td>
<td rowspan="5">COMMENTS</td>
</tr>
<tr class="even">
<td colspan="2">5. Without Meals</td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2">6. With breakfast</td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="2">7. With breakfast and dinner</td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2">8. With all meals</td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="10"><p>The reported rates include:  Taxes  Service
Charges  Discounts for All USG Personnel</p>
<p>Reported in local currency?  Yes  No</p></td>
<td colspan="2"><p># of rooms in hotel:</p>
<p># of reservations from post log</p></td>
</tr>
<tr class="odd">
<td colspan="11"><p>Third most used hotel:</p>
<p>Location:</p></td>
<td rowspan="5">COMMENTS</td>
</tr>
<tr class="even">
<td colspan="2">9. Without Meals</td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2">10. With breakfast</td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="2">11. With breakfast and dinner</td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2">12. With all meals</td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="10"><p>The reported rates include:  Taxes  Service
Charges  Discounts for All USG Personnel</p>
<p>Reported in local currency?  Yes  No</p></td>
<td colspan="2"><p># of rooms in hotel:</p>
<p># of reservations from post log</p></td>
</tr>
<tr class="odd">
<td colspan="11"><p>Other lodging facilities typically used by larger
families:</p>
<p>Location:</p></td>
<td rowspan="5">COMMENTS</td>
</tr>
<tr class="even">
<td colspan="2">13. Without Meals</td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2">14. With breakfast</td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="2">15. With breakfast and dinner</td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2">16. With all meals</td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="10"><p>The reported rates include:  Taxes  Service
Charges  Discounts for All USG Personnel</p>
<p>Reported in local currency?  Yes  No</p></td>
<td colspan="2"><p># of rooms in hotel:</p>
<p># of reservations from post log</p></td>
</tr>
<tr class="odd">
<td colspan="12">*17. Hotel high-season rates are in effect from about
____________(mo/day/yr) through _______________ (mo/day/yr.).</td>
</tr>
<tr class="even">
<td colspan="12">18. List hotels most used by:</td>
</tr>
<tr class="odd">
<td colspan="4">PER DIEM TRAVELERS</td>
<td colspan="4" rowspan="2"><p>PERSONNEL IN</p>
<p>TEMPORARY LODGING</p></td>
<td colspan="4" rowspan="2">U.S. TOURISTS</td>
</tr>
<tr class="even">
<td>CIVILIANS</td>
<td colspan="3">MILITARY</td>
</tr>
<tr class="odd">
<td></td>
<td colspan="3"></td>
<td colspan="4"></td>
<td colspan="4"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="3"></td>
<td colspan="4"></td>
<td colspan="4"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="3"></td>
<td colspan="4"></td>
<td colspan="4"></td>
</tr>
<tr class="even">
<td colspan="12"><p> Check box if hotels reported as "most used" by
Federal Travelers are based on hotel records maintained by the post.
List the number of reservations made for each hotel.</p>
<p>Note: The instructions on page 41 &amp; in Sec. 950 of the Department
of State's Standardized Regulations (DSSR) must be followed in
completing this page.</p></td>
</tr>
</tbody>
</table>

+----------------------------+-------+--------------------------------+
| Interagency Report Control |       |                                |
| No. 1168-DOS-AN            |       |                                |
|                            |       |                                |
| **UNITED STATES DEPARTMENT |       |                                |
| OF STATE**                 |       |                                |
|                            |       |                                |
| Embassy or Consulate Store |       |                                |
| Report (DSP-23E)           |       |                                |
+----------------------------+-------+--------------------------------+
|                            | S     |                                |
|                            | urvey |                                |
|                            | Loca  |                                |
|                            | tion: |                                |
+----------------------------+-------+--------------------------------+
|                            | U.S.  |                                |
|                            | A     |                                |
|                            | gency |                                |
+----------------------------+-------+--------------------------------+
|                            | Date  |                                |
|                            | of    |                                |
|                            | S     |                                |
|                            | urvey |                                |
|                            | (Date |                                |
|                            | most  |                                |
|                            | data  |                                |
|                            | are   |                                |
|                            | colle |                                |
|                            | cted) |                                |
+----------------------------+-------+--------------------------------+
| INSTRUCTIONS               |       |                                |
|                            |       |                                |
| a\) BEFORE BEGINNING THIS  |       |                                |
| REPORT, REVIEW THE         |       |                                |
| INSTRUCTIONS IN THE SURVEY |       |                                |
| HANDBOOK PORTION (SECTION  |       |                                |
| 950) OF THE DEPARTMENT OF  |       |                                |
| STATE STANDARDIZED         |       |                                |
| REGULATIONS (DSSR).        |       |                                |
| REPORTS PREPARED FOR       |       |                                |
| UNIFORMED SERVICE MEMBERS  |       |                                |
| MUST FOLLOW PROCEDURES     |       |                                |
| PROVIDED IN APPENDIX M OF  |       |                                |
| THE JOINT FEDERAL TRAVEL   |       |                                |
| REGULATIONS                |       |                                |
|                            |       |                                |
| \(b\) If there has been a  |       |                                |
| previous survey, it must   |       |                                |
| be used as a guide in      |       |                                |
| preparing this report.     |       |                                |
|                            |       |                                |
| \(c\) Report prices in     |       |                                |
| currency used for actual   |       |                                |
| purchases by Americans.    |       |                                |
| Explain any use of         |       |                                |
| non-local currencies in    |       |                                |
| local retail outlets.      |       |                                |
|                            |       |                                |
| \(d\) Explain on each page |       |                                |
| of the report the          |       |                                |
| availability of any        |       |                                |
| \"cash\" or other special  |       |                                |
| discounts.                 |       |                                |
|                            |       |                                |
| \(e\) Use the space        |       |                                |
| provided to describe       |       |                                |
| brand, quality, origin, or |       |                                |
| other pertinent details    |       |                                |
| about the item.            |       |                                |
|                            |       |                                |
| Survey Exchange Rate:      |       |                                |
|                            |       |                                |
| Source of Exchange Rate    |       |                                |
| (e.g., bank, USG facility, |       |                                |
| etc.):                     |       |                                |
|                            |       |                                |
| Date of Exchange Rate      |       |                                |
| Information (effective the |       |                                |
| date of the survey):       |       |                                |
+----------------------------+-------+--------------------------------+
| [Survey                    |       | OFFICER WITH OVERALL           |
| R                          |       | RESPONSIBILITY                 |
| esponsibility]{.underline} |       |                                |
|                            |       | FOR THIS SURVEY                |
| Indicate below the signed  |       |                                |
| concurrence of             |       | I hereby certify that this     |
| representatives of all     |       | report was prepared in         |
| U.S. Government Agencies   |       | accordance with instructions   |
| at post affected by this   |       | in the survey handbook, DSSR   |
| report (including military |       | Section 950.                   |
| component):                |       |                                |
|                            |       | I also certify that the last   |
| [Agency]{.underline}       |       | living pattern survey was      |
| [Names of                  |       | completed in full compliance   |
| Re                         |       | with the instructions in the   |
| presentatives]{.underline} |       | DSSR.                          |
|                            |       |                                |
| List the individuals       |       |                                |
| responsible for price      |       |                                |
| collection:                |       |                                |
|                            |       |                                |
| [Agency]{.underline}       |       |                                |
| [Names of Price            |       |                                |
| Collectors]{.underline}    |       |                                |
+----------------------------+-------+--------------------------------+
|                            |       | Signature of Certifying        |
|                            |       | Official                       |
+----------------------------+-------+--------------------------------+
|                            |       | Name (Printed or Typed)        |
+----------------------------+-------+--------------------------------+
|                            |       | Title                          |
|                            |       |                                |
|                            |       | Date Survey Began:             |
|                            |       |                                |
|                            |       | Date Completed:                |
+----------------------------+-------+--------------------------------+

Form DSP-23E Revised 10/98 EMBASSY OR CONSULATE STORE REPORT (FORM
DSP-23E)

  -----------------------------------------------------------------------
  **CATEGORY: MEAT AND DAIRY PRODUCTS**

  -----------------------------------------------------------------------

+--------------+-------+--------+--------+--------+------------------+
| **MEAT AND   |       | QU     | UNIT   | PRICE  | DESCRIPTION      |
| DAIRY        |       | ANTITY |        |        |                  |
| PRODUCTS**   |       |        | (lb    |        |                  |
|              |       |        | ./kg.) |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| **Embassy or |       |        |        |        |                  |
| Consulate    |       |        |        |        |                  |
| Facility**   |       |        |        |        |                  |
|              |       |        |        |        |                  |
| NAME(S):     |       |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| 1\. Beef     | Steak |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Roast |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Hamb  |        |        |        |                  |
|              | urger |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| 2\. Pork     | Chops |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Loin  |        |        |        |                  |
|              | Roast |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| 3\. Lamb     | Lamp  |        |        |        |                  |
|              | Chops |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Leg   |        |        |        |                  |
|              | of    |        |        |        |                  |
|              | Lamb  |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| 4\. Fish,    | Ty    |        |        |        |                  |
| Fresh Filet  | pical |        |        |        |                  |
|              |       |        |        |        |                  |
| (uncooked,   |       |        |        |        |                  |
| specify      |       |        |        |        |                  |
| type)        |       |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Subst |        |        |        |                  |
|              | itute |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Ec    |        |        |        |                  |
|              | onomy |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| 5\. Fish,    | Ty    |        |        |        |                  |
| Canned       | pical |        |        |        |                  |
|              |       |        |        |        |                  |
| (specify     |       |        |        |        |                  |
| type)        |       |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Subst |        |        |        |                  |
|              | itute |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Ec    |        |        |        |                  |
|              | onomy |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| 6\. Chicken, | Ty    |        |        |        |                  |
| Whole        | pical |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Subst |        |        |        |                  |
|              | itute |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Ec    |        |        |        |                  |
|              | onomy |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| 7\. Eggs     | per   |        | Eggs   |        |                  |
|              | dozen |        |        |        |                  |
|              | or 10 |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| 8\. Ice      | Ty    |        |        |        |                  |
| Cream        | pical |        |        |        |                  |
|              |       |        |        |        |                  |
| (per liter   |       |        |        |        |                  |
| or quart)    |       |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Ec    |        |        |        |                  |
|              | onomy |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| 9\.          | Ty    |        |        |        |                  |
| Margarine    | pical |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Ec    |        |        |        |                  |
|              | onomy |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| 10\. Cheese  | Ty    |        |        |        |                  |
|              | pical |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Subst |        |        |        |                  |
|              | itute |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Ec    |        |        |        |                  |
|              | onomy |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| Comments:    |       |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+

MEAT AND DAIRY PRODUCTS

  -----------------------------------------------------------------------
  **CATEGORY: GROCERIES**

  -----------------------------------------------------------------------

+--------------+-------+--------+--------+--------+------------------+
| *            |       | QU     | UNIT   | PRICE  | DESCRIPTION      |
| *GROCERIES** |       | ANTITY |        |        |                  |
|              |       |        | (lb    |        |                  |
|              |       |        | ./kg.) |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| **Embassy or |       |        |        |        |                  |
| Consulate    |       |        |        |        |                  |
| Facility**   |       |        |        |        |                  |
|              |       |        |        |        |                  |
| NAME(S):     |       |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| 1\. Milk,    | Ty    |        |        |        |                  |
| Fresh        | pical |        |        |        |                  |
|              |       |        |        |        |                  |
| (per liter   |       |        |        |        |                  |
| or quart)    |       |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Subst |        |        |        |                  |
|              | itute |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Ec    |        |        |        |                  |
|              | onomy |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| 2\. Milk,    | Ty    |        |        |        |                  |
| Dried        | pical |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Subst |        |        |        |                  |
|              | itute |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Ec    |        |        |        |                  |
|              | onomy |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| 3\. Bread,   | Ty    |        |        |        |                  |
| White        | pical |        |        |        |                  |
| (sliced)     |       |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Ec    |        |        |        |                  |
|              | onomy |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| 4\. Flour    | Ty    |        |        |        |                  |
|              | pical |        |        |        |                  |
| (Bread or    |       |        |        |        |                  |
| General      |       |        |        |        |                  |
|              |       |        |        |        |                  |
| Purpose)     |       |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Ec    |        |        |        |                  |
|              | onomy |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| 5\. Cereal,  | Ty    |        |        |        |                  |
| Breakfast    | pical |        |        |        |                  |
|              |       |        |        |        |                  |
| (R           |       |        |        |        |                  |
| eady-to-eat) |       |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Subst |        |        |        |                  |
|              | itute |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Ec    |        |        |        |                  |
|              | onomy |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| 6\. Rice,    | Ty    |        |        |        |                  |
| Regular      | pical |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Subst |        |        |        |                  |
|              | itute |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Ec    |        |        |        |                  |
|              | onomy |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| 7\. Pasta    | Ty    |        |        |        |                  |
| (uncooked)   | pical |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Subst |        |        |        |                  |
|              | itute |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Ec    |        |        |        |                  |
|              | onomy |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| 8\. Tea,     | Ty    |        |        |        |                  |
| Bags         | pical |        |        |        |                  |
| (specify \#  |       |        |        |        |                  |
| of           |       |        |        |        |                  |
|              |       |        |        |        |                  |
| bags)        |       |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Subst |        |        |        |                  |
|              | itute |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Ec    |        |        |        |                  |
|              | onomy |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| 9\. Coffee,  | Ty    |        |        |        |                  |
| Ground       | pical |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Subst |        |        |        |                  |
|              | itute |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Ec    |        |        |        |                  |
|              | onomy |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| 10\. Coffee, | Ty    |        |        |        |                  |
| Instant      | pical |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Subst |        |        |        |                  |
|              | itute |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Ec    |        |        |        |                  |
|              | onomy |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| Comments:    |       |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+

GROCERIES

  -----------------------------------------------------------------------
  **CATEGORY: GROCERIES (CON\'T)**

  -----------------------------------------------------------------------

+--------------+-------+--------+--------+--------+------------------+
| *            |       | QU     | UNIT   | PRICE  | DESCRIPTION      |
| *GROCERIES** |       | ANTITY |        |        |                  |
|              |       |        | (ml    |        |                  |
|              |       |        | /fluid |        |                  |
|              |       |        | oz.)   |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| **Embassy or |       |        |        |        |                  |
| Consulate    |       |        |        |        |                  |
| Facility**   |       |        |        |        |                  |
|              |       |        |        |        |                  |
| NAME(S):     |       |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| 1\. Soft     | Ty    |        |        |        |                  |
| Drink,       | pical |        |        |        |                  |
| Carbonated\* |       |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Subst |        |        |        |                  |
|              | itute |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Ec    |        |        |        |                  |
|              | onomy |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| 2\. Locally  | Ty    |        |        |        |                  |
| Bottled      | pical |        |        |        |                  |
|              |       |        |        |        |                  |
| Drinking     |       |        |        |        |                  |
| Water\*      |       |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Subst |        |        |        |                  |
|              | itute |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Ec    |        |        |        |                  |
|              | onomy |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| 3\. Candy,   | Ty    |        |        |        |                  |
| Chocolate    | pical |        |        |        |                  |
| Bar          |       |        |        |        |                  |
|              |       |        |        |        |                  |
| (Plain)      |       |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Subst |        |        |        |                  |
|              | itute |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Ec    |        |        |        |                  |
|              | onomy |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| 4\. Sugar,   | Ty    |        |        |        |                  |
| Granulated   | pical |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Subst |        |        |        |                  |
|              | itute |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Ec    |        |        |        |                  |
|              | onomy |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| 5\. Baby     | Ty    |        |        |        |                  |
| Food         | pical |        |        |        |                  |
| (exclude     |       |        |        |        |                  |
|              |       |        |        |        |                  |
| meat)        |       |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Subst |        |        |        |                  |
|              | itute |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Ec    |        |        |        |                  |
|              | onomy |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| 6\. Fats,    | Ty    |        |        |        |                  |
| Other        | pical |        |        |        |                  |
| (cooking     |       |        |        |        |                  |
| oil)         |       |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Ec    |        |        |        |                  |
|              | onomy |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| \*List any   |       |        |        |        |                  |
| bottle       |       |        |        |        |                  |
| deposits for |       |        |        |        |                  |
| soda/bottled |       |        |        |        |                  |
| water        |       |        |        |        |                  |
| separately   |       |        |        |        |                  |
| in the       |       |        |        |        |                  |
| description  |       |        |        |        |                  |
| column.      |       |        |        |        |                  |
|              |       |        |        |        |                  |
| Comments:    |       |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+

  -----------------------------------------------------------------------
  **CATEGORY: ALCOHOL/TOBACCO**

  -----------------------------------------------------------------------

+--------------+-------+--------+--------+--------+------------------+
| **           |       | QU     | UNIT   | PRICE  | BRAND AND        |
| SUBCATEGORY: |       | ANTITY |        |        | DESCRIPTION      |
| ALCOHOL**    |       |        | (ml    |        |                  |
|              |       |        | /fluid |        |                  |
|              |       |        | oz.)   |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| Wine, Table  | Ty    |        |        |        |                  |
| (1 bottle)   | pical |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Subst |        |        |        |                  |
|              | itute |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Ec    |        |        |        |                  |
|              | onomy |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| Whiskey      | Ty    |        |        |        |                  |
| (scotch,     | pical |        |        |        |                  |
| rye, etc.)   |       |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Subst |        |        |        |                  |
|              | itute |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Ec    |        |        |        |                  |
|              | onomy |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+

GROCERIES/ALCOHOL AND TOBACCO

+--------------+-------+--------+--------+--------+------------------+
| **CATEGORY:  |       |        |        |        |                  |
| ALC          |       |        |        |        |                  |
| OHOL/TOBACCO |       |        |        |        |                  |
| (CON\'T.)**  |       |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| **Embassy or |       |        |        |        |                  |
| Consulate    |       |        |        |        |                  |
| Facility**   |       |        |        |        |                  |
|              |       |        |        |        |                  |
| Name:        |       |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| **           |       | QU     | UNIT   | PRICE  | BRAND AND        |
| SUBCATEGORY: |       | ANTITY |        |        | DESCRIPTION      |
| ALCOHOL**    |       |        | (ml    |        |                  |
|              |       |        | /fluid |        |                  |
|              |       |        | oz.)   |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| Beer\*       | Ty    |        |        |        |                  |
|              | pical |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Subst |        |        |        |                  |
|              | itute |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Ec    |        |        |        |                  |
|              | onomy |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| **           |       | QU     | UNIT   | PRICE  | BRAND AND        |
| SUBCATEGORY: |       | ANTITY |        |        | DESCRIPTION      |
| C            |       |        | (c     |        |                  |
| IGARETTESL** |       |        | arton) |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| Cigarettes   | Ty    |        |        |        |                  |
| (carton of   | pical |        |        |        |                  |
| 200)         |       |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Subst |        |        |        |                  |
|              | itute |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Ec    |        |        |        |                  |
|              | onomy |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| \*List any   |       |        |        |        |                  |
| bottle       |       |        |        |        |                  |
| deposits for |       |        |        |        |                  |
| beer         |       |        |        |        |                  |
| separately   |       |        |        |        |                  |
| in the       |       |        |        |        |                  |
| description  |       |        |        |        |                  |
| column.      |       |        |        |        |                  |
|              |       |        |        |        |                  |
| *            |       |        |        |        |                  |
| *Comments:** |       |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+

  -----------------------------------------------------------------------
  **CATEGORY: FRUITS/VEGETABLES**

  -----------------------------------------------------------------------

+-----------------------+--------+--------+--------+------------------+
| **SUBCATEGORY: FRUIT, | QU     | UNIT   | PRICE  | BRAND AND        |
| FRESH**               | ANTITY |        |        | DESCRIPTION      |
|                       |        | (lb    |        |                  |
|                       |        | ./kg.) |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 1\. Oranges           |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 2\. Lemons            |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 3\. Apples            |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 4\. Bananas           |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 5\. Pineapples        |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| **SUBCATEGORY: JUICE, | QU     | UNIT   | PRICE  | BRAND AND        |
| CANNED**              | ANTITY |        |        | DESCRIPTION      |
|                       |        | (ml    |        |                  |
|                       |        | /fluid |        |                  |
|                       |        | oz.)   |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 1\. Apple Juice       |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 2\. Orange Juice      |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 3\. Tomato Juice      |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| **SUBCATEGORY:        | QU     | UNIT   | PRICE  | BRAND AND        |
| VEGETABLES, FRESH**   | ANTITY |        |        | DESCRIPTION      |
|                       |        | (lb    |        |                  |
|                       |        | ./kg.) |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 1\. Potatoes, White   |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 2\. Potatoes, Baking  |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 3\. Beans, Green      |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 4\. Cabbage           |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 5\. Carrots           |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 6\. Eggplant          |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+

TOBACCO AND ALCOHOL/FRUITS AND VEGETABLES

  -----------------------------------------------------------------------
  **CATEGORY: FRUITS/VEGETABLES (CON\'T.)**

  -----------------------------------------------------------------------

+-----------------------+--------+--------+--------+------------------+
| **Embassy or          |        |        |        |                  |
| Consulate Facility**  |        |        |        |                  |
|                       |        |        |        |                  |
| Name:                 |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 7\. Lettace           |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 8\. Onions            |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 9\. Squash            |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 10\. Tomatoes         |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 11\. Broccoli         |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| **SUBCATEGORY: FRUIT, | QU     | UNIT   | PRICE  | BRAND AND        |
| CANNED**              | ANTITY |        |        | DESCRIPTION      |
|                       |        | (gram/ |        |                  |
|                       |        | ounce) |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 1\. Applesauce        |        |        |        |                  |
| (822-879gr/29-31oz.)  |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 2\. Peaches           |        |        |        |                  |
| (822-879gr/29-31oz.)  |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 3\. Pineapples        |        |        |        |                  |
| (822-879gr/29-31oz.)  |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 4\. Pears             |        |        |        |                  |
| (822-879gr/29-31oz.)  |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| **SUBCATEGORY:        | QU     | UNIT   | PRICE  | BRAND AND        |
| VEGETABLES, CANNED**  | ANTITY |        |        | DESCRIPTION      |
|                       |        | (gram/ |        |                  |
|                       |        | ounce) |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 1\. Beans, String     |        |        |        |                  |
| (425-482gr/15-17oz.)  |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 2\. Peas, Green       |        |        |        |                  |
| (425-482gr/15-17oz.)  |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 3\. Corn              |        |        |        |                  |
| (425-482gr/15-17oz.)  |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 4\. Tomatoes          |        |        |        |                  |
| (425-482gr/15-17oz.)  |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| **SUBCATEGORY:        | QU     | UNIT   | PRICE  | BRAND AND        |
| VEGETABLES, FROZEN**  | ANTITY |        |        | DESCRIPTION      |
|                       |        | (gram/ |        |                  |
|                       |        | ounce) |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 1\. Spinach           |        |        |        |                  |
| (284gr/10oz.)         |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 2\. Beans, String     |        |        |        |                  |
| (284gr/10oz.)         |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 3\. Peas, Green       |        |        |        |                  |
| (284gr/10oz.)         |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| 4\. French Fries      |        |        |        |                  |
| (284gr/10oz.)         |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+
| **Comments:**         |        |        |        |                  |
+-----------------------+--------+--------+--------+------------------+

FRUITS AND VEGETABLES

  -----------------------------------------------------------------------
  **CATEGORY: PERSONAL CARE**

  -----------------------------------------------------------------------

+--------------+-------+--------+--------+--------+------------------+
| **           |       | QU     | UNIT   | PRICE  | BRAND AND        |
| SUBCATEGORY: |       | ANTITY |        |        | DESCRIPTION      |
| TOILETRIES** |       |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| **Embassy or |       |        |        |        |                  |
| Consulate    |       |        |        |        |                  |
| Facility**   |       |        |        |        |                  |
|              |       |        |        |        |                  |
| NAME(S):     |       |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| 1\.          | Ty    |        |        |        |                  |
| Toothpaste   | pical |        |        |        |                  |
| (198g./7oz.) |       |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Subst |        |        |        |                  |
|              | itute |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Ec    |        |        |        |                  |
|              | onomy |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| 2\. Razor    | Ty    |        |        |        |                  |
| Blades       | pical |        |        |        |                  |
|              |       |        |        |        |                  |
| (pkg. of     |       |        |        |        |                  |
| 5-10 twin    |       |        |        |        |                  |
| blades)      |       |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Subst |        |        |        |                  |
|              | itute |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Ec    |        |        |        |                  |
|              | onomy |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| 3\. Sanitary | Ty    |        |        |        |                  |
| Napkins      | pical |        |        |        |                  |
|              |       |        |        |        |                  |
| (box of 24)  |       |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Subst |        |        |        |                  |
|              | itute |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Ec    |        |        |        |                  |
|              | onomy |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| 4\. Hair     | Ty    |        |        |        |                  |
| Shampoo      | pical |        |        |        |                  |
|              |       |        |        |        |                  |
| (450ml/16    |       |        |        |        |                  |
| fluid oz.)   |       |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Subst |        |        |        |                  |
|              | itute |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Ec    |        |        |        |                  |
|              | onomy |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+

  -----------------------------------------------------------------------
  **CATEGORY: FURNISHINGS/HOUSEHOLD**

  -----------------------------------------------------------------------

+--------------+-------+--------+--------+--------+------------------+
| **           |       | QU     | UNIT   | PRICE  | BRAND AND        |
| SUBCATEGORY: |       | ANTITY |        |        | DESCRIPTION      |
| HOUSEHOLD    |       |        |        |        |                  |
| C            |       |        |        |        |                  |
| ONSUMABLES** |       |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| 1\. Laundry  | Ty    |        |        |        |                  |
| Detergent,   | pical |        |        |        |                  |
|              |       |        |        |        |                  |
| Liquid or    |       |        |        |        |                  |
| Powdered     |       |        |        |        |                  |
|              |       |        |        |        |                  |
| (ml/fl. oz.  |       |        |        |        |                  |
| or           |       |        |        |        |                  |
| grams/oz.)   |       |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Subst |        |        |        |                  |
|              | itute |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Ec    |        |        |        |                  |
|              | onomy |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| 2\. Toilet   | Ty    |        |        |        |                  |
| Tissue       | pical |        |        |        |                  |
| (specify \#  |       |        |        |        |                  |
|              |       |        |        |        |                  |
| of rolls and |       |        |        |        |                  |
| sheets per   |       |        |        |        |                  |
| roll)        |       |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Subst |        |        |        |                  |
|              | itute |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Ec    |        |        |        |                  |
|              | onomy |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| 3\. Diapers, | Ty    |        |        |        |                  |
| Disposable   | pical |        |        |        |                  |
|              |       |        |        |        |                  |
| (pkg. of 48) |       |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Subst |        |        |        |                  |
|              | itute |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Ec    |        |        |        |                  |
|              | onomy |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| *            |       |        |        |        |                  |
| *Comments:** |       |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+

PERSONAL CARE/FURNISHINGS/HOUSEHOLD

  -----------------------------------------------------------------------
  **CATEGORY: MEDICAL**

  -----------------------------------------------------------------------

+--------------+-------+--------+--------+--------+------------------+
| **           |       | QU     | UNIT   | PRICE  | BRAND AND        |
| SUBCATEGORY: |       | ANTITY |        |        | DESCRIPTION      |
| MEDICINE**   |       |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| **Embassy or |       |        |        |        |                  |
| Consulate    |       |        |        |        |                  |
| Facility**   |       |        |        |        |                  |
|              |       |        |        |        |                  |
| NAME(S):     |       |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| Pain         | Ty    |        |        |        |                  |
| Reliever     | pical |        |        |        |                  |
| Compound     |       |        |        |        |                  |
|              |       |        |        |        |                  |
| 100 tabs,    |       |        |        |        |                  |
| 325 mg.      |       |        |        |        |                  |
| strength     |       |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
|              | Subst |        |        |        |                  |
|              | itute |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+
| *            |       |        |        |        |                  |
| *Comments**: |       |        |        |        |                  |
+--------------+-------+--------+--------+--------+------------------+

  -----------------------------------------------------------------------
  **CATEGORY: RECREATION**

  -----------------------------------------------------------------------

+--------------+------------+-------+---------------------------------+
| **           |            | PRICE | BRAND AND DESCRIPTION           |
| SUBCATEGORY: |            |       |                                 |
| AUDIO/VISUAL |            |       |                                 |
| SUPPLIES**   |            |       |                                 |
+--------------+------------+-------+---------------------------------+
| 1\. Video    | Typical    |       |                                 |
| Tape, Blank  |            |       |                                 |
|              |            |       |                                 |
| (VHS T-120)  |            |       |                                 |
+--------------+------------+-------+---------------------------------+
|              | Substitute |       |                                 |
+--------------+------------+-------+---------------------------------+
|              | Economy    |       |                                 |
+--------------+------------+-------+---------------------------------+
| **           |            | PRICE | BRAND AND DESCRIPTION           |
| SUBCATEGORY: |            |       |                                 |
| PHOTOGRAPHIC |            |       |                                 |
| SUPPLIES**   |            |       |                                 |
+--------------+------------+-------+---------------------------------+
| 1\. Film     | Typical    |       |                                 |
| Processing   |            |       |                                 |
|              |            |       |                                 |
| (24          |            |       |                                 |
| exposure,    |            |       |                                 |
| 35mm)        |            |       |                                 |
+--------------+------------+-------+---------------------------------+
|              | Substitute |       |                                 |
+--------------+------------+-------+---------------------------------+
|              | Economy    |       |                                 |
+--------------+------------+-------+---------------------------------+
| 2\. Camera   | Typical    |       |                                 |
| Film         |            |       |                                 |
|              |            |       |                                 |
| (24          |            |       |                                 |
| exposure,    |            |       |                                 |
| 35mm)        |            |       |                                 |
+--------------+------------+-------+---------------------------------+
|              | Substitute |       |                                 |
+--------------+------------+-------+---------------------------------+
|              | Economy    |       |                                 |
+--------------+------------+-------+---------------------------------+
| **           |            | PRICE | BRAND AND DESCRIPTION           |
| SUBCATEGORY: |            |       |                                 |
| READING      |            |       |                                 |
| MATERIAL**   |            |       |                                 |
+--------------+------------+-------+---------------------------------+
| 1\. Book,    | Typical    |       |                                 |
| Paperback    |            |       |                                 |
+--------------+------------+-------+---------------------------------+
|              | Substitute |       |                                 |
+--------------+------------+-------+---------------------------------+
|              | Economy    |       |                                 |
+--------------+------------+-------+---------------------------------+
| 2\.          | Local      |       |                                 |
| Newspaper,   |            |       |                                 |
| Daily        |            |       |                                 |
+--------------+------------+-------+---------------------------------+
| 3\. News     | Typical    |       |                                 |
| Magazine,    |            |       |                                 |
|              |            |       |                                 |
| Weekly       |            |       |                                 |
+--------------+------------+-------+---------------------------------+
|              | Substitute |       |                                 |
+--------------+------------+-------+---------------------------------+
| *            |            |       |                                 |
| *Comments**: |            |       |                                 |
+--------------+------------+-------+---------------------------------+

MEDICAL AND RECREATION