Page 20

DAILY REMINDER LIST

PP Please review the list of expenses below with other members of your
household at the end of each day. If you hove forgotten to record any
expense, please do so on the appropriate page.

EXPENSES FOR:

a. Food and beverages purchased at a restaurant or carry-out (including
school lunches and vending machine purchases)

b. Snack foods (potato chips, pretzels, etc.)

c. Beer, wine, whiskey, and other alcoholic beverages

d, Cigarettes, tobacco, or other smoking supplies

e. Lumber, nails, sandpaper, paint brushes, etc.

§. Gasoline, turnpike or bridge tolls, parking fees, car poo! expenses, etc.
g. Newspapers, postage stamps, greeting cards, etc.

h. Vitamins, medicine, and other medical or sanitary supplies

i. Laundry and dry cleaning (including coin-operated machines used at
a laundromat)

j. Hair cuts and sets (including purchase and care of wigs and hair pieces)
k. Toys, hobbies, games, etc.

Il. Bank charges for checking accounts, safe -deposit boxes, etc.

FORM CE-108 (4-8-73)

GPC: 1973 - 501-787



Page 14

SIXTH DAY Bay
Nole: If you need additional space for any category, use pages 18 and 19.
FOOD AND BEVERAGES
OFFICE Item Number Net weight (ho ata) Total cost
on (Describe the item purchased, such os bottles, | volume per unit FT gt (Exclude
NLY whole milk, T-bone steak, dried apricots, packages, (Examples: Sik. ¢ 3
oll purpose flour, soltines, etc.) etc. E! 2! 8! Ethnae lem
~ 56 010 | Dairy and Bakery Products 1 !
(dicate if milk is delivered) 1 '
A T12 3 V
B 1 1z —
L
c re !
dD 1 t |
E Y 2 i
F tia !
G 1 12 H
H 2 H
J i? i”
K v 2 Hl
Weat, Fiah, and Poultry (Jidicate the cut of meat) i Hl
L Tf fs '
M vo2 33 14 i
N + 12314 rT
io —_
P TR 1s ta 1
Q vis fa }
R eo
$ t 1 te 13 Ta |
T ye 134
U _ v2 |3 14 4
~ 56 028 Frults and Vegetables (Indicate if dried)
A '? Poi fs 1
8 eo L
c et |
D oe 1
E ee an
F ‘RT iA i
G ro 73 4 f
H ~~ Ye 344 i
- jo 1
1 ee H
K ee 1
Boverages io. t
L '? 8 of fs t
PR Pt a
N a ' 2 3 “4 i)
Pp 1 (2 13 4 '
a tog !
a - ee _
R 1 2 j EY \* '
~ 56 036 | ait other Foods 1
rn a
B 1 i 3 2 !
5 et
5 wh
roy n
F ‘Poe A
S ‘ep L
H ‘oe H
3 ‘foe if H
K ‘et _
L 1 a & if i
ry Tee ‘
N an ae !
P Te 8 j
Q 1 2 2 iu t

FORM CE-108 (448-73!


Page 5

FIRST DAY Ore
Pc
MEALS AND SNACKS PURCHASED AT A RESTAURANT, CARRY-OUT, ETC.
OFFICE item Was this purchased at a — Tolal cost

USE {Mark one)

ONLY (lachude breakfasts, dinners, schoo! lunches, H T r i {include
snacks, and drinks purchosed of a restaurant, . | Drive-in oot ips,
har, vending machine, ete.) Restau- | Cafe- jg, 1 Venging | they

31 047 fant 1 FEN12 | ese oyp ! machine |
H i H ! Dollars 2 Cents|
1 H 1 rT H
1 1 '
A i 8 " 5 $ j
4 2 3 4 1s 1
B n H | 1 1
c a | 2 H { 4 & !
1 12 13 Ly s '
D t 1 1 a 1
ALL OTHER PURCHASES AND EXPENSES
Total cost Total cost
OFFICE
USE Item (Exclude ores tem (Exclude
ONLY (Describe the item purchosed) soles tox) ONLY (Describe the item purchased) soles tax)
Dollars {Cents Dollars {Cents
i] 1
~ 21 055 |cteaning, Laundry Supplles, ! ~ 21 089 Honsowares, Furalshings, Hardware, \
and Paper Products ! (mirrors, light bulbs, nails, etc.) H
4 $ Hl Al $ i
8 i__|e. H
C i c i
D i D i
E i E {
F i F i
G i 6 i
Newspapers, Books, Postage, ! !
Sateney sad School Supiiies ! Tobacco and Smaking Suppiles !
H 3 i H 3 i
J i J 1
i K H
~ 21 063 | Personal Care, Drugs, and t ~ Gas, Oll, Tolls, Parking Fees, !
63 Medical Supplies — ‘ 21 097 and Other Vehicla Expenses; '
(Indicate if prescribed by a doctor) H Public Transportation Expenses ‘
t ’
A sy A $ L
B H 8 Hl
c Hl c Hl
T = Thothing, Shoes, Jewelry, and Linens r
D ! 31 104 | (sich as dress shirts, work shirts, !
€ Hl casual slacks, etc.) I
F Hi o S ;
6 mG
H i F T
J H 6 H
Laundry and Diaper Service, H Rent, Utilities, Fuel, Phone, Insurance — i
Beauty and Barber Shop, I (Specify period covered by expense, I
Household Help, Babysitters i such os week, month, year) —y i
K $ 1 H $ i
pL | _ . i) J 1
M ! « 1
N 1 L 1
Pp ' ~ 21 113 | other Purchases and Expenses H
Q i (toys, hobbies, contributions, etc.) 1
R ! M $ !
Movies, Plays, Other Entertainment, H N i.
Ctub and Other Membership Dues I P 1
h L
$ $ H Q H
T |_|e
vu Hl $ ,
GIFTS
OFFICE Was this purchased
USE tem {or a member of Tolal cost
ONLY this household? (Exclude
(Describe the item purchosed) (Mark one) soles tox)
~ 31070 Yes | NO | Dollars [Cents
1 t
A ‘ ig $ H A
B ' i j
c ' \2 I
D 1 i? H

FORM CE-108 (4-3-78)



Page |8

Use these pages for any purchases or expenses for which you did not
ADDITIONAL PAGE have enough space to enter on the appropriate day page. Enter the
day (Mon., Tue., etc.) in the column headed ‘'Day."*
FOOD AND BEVERAGES
Number Net weight (s this item - T
: otal cost
OFFICE hem cf cans, or (ark only one} Peetu
USE Day | (Describe the item purchased such as bottles, velume per unit lele oles 1 <)
ONLY whole milk, T-bone steok, dried epricots, | sackages (Examples: $18) 2,8| °°"
all purpose flour, soltines, etc.) . Boz, 1 gh, S$; 38; Ss, £
ete. 5 lbs., etc.) ry © | G1 | Dollars Cents
——-
~ 68 015 H ' i
Dalry and Bakery Products ! } ! |
A | T 2 7 Ts 1
Bi 1 2 a i
1 i _| 1
c 1 42 ia t
~ .
D T1243 4a
t 2 3 4 7
a aoe F
F 1 12 |3 4 i
G ~ tz 3a 1
i — i
112 3 4 '
LH oo i_|
1 T
J t i js i! ul
K y Tie ae 1
Meat, Fish, and Poultry ror :
L fi Zz 3 1 Jy i
M T 12 )3 08 H
N rye 434 '
: 1
Te 3 H
[P| er !
Q toyz 3 ta
14 L —
12 13 14
R PoP ‘
Ss 1 T2 13 14 ‘
ly] i213
U vo
~ 68 02 y fi 1 '
3 Frults and Vegetables ! ‘ 1 {
i
A ’ \2 3 4 $ !
B ; ’ 2 3 4 {
1 12 3 4
c 4 i { L
1 12 9 14 i}
o 1 a 1 u
t t t
E 1 i? 13 i \
F To
a
C rye 73 [a H
bal 1 2 |3 14 i
i 1 2
J T1213 14 i
a 1
K i} voi 1a 44
| oe L .
Beverages Tt t
t i t T
L ‘Pov if ds '
M Ts H
N 7 2 Ta Ta t
P H | Ce ae i
va i344 1
Q n i l 1
T \2 318 T
a : Pe
~ 68 031 i!
$8 All Other Foods fot 4 i
t 4 L 4
i] T T
ry ae a |
B Te i
Cc 1 2 3 14 j
E Te
2 13 7
E ‘ 4 H 4 i
1 2 '
F po 1
G 1 12 13 !
H ‘2 1
1 2 !
s f |
4 '
K 1? 1
L 112 i
M4 12 j
i
N 12
1 2
P i
T 12
Q | ! !

FORM CE-108 (4-3-78)


Page 10

FOURTH DAY DAY
> Note: If you need additional space for any category, use pages 18 and 19,
FOOD AND BEVERAGES
OFFICE Item ; Humber | Net weight ork colton) _| Total cost
USE (Describe the Item purchased, such os bottles, | volume per unit Ter Bt (Exclude
ONLY whole milk, T-bone steak, dried opricots, | packages, (Exomples: Si 81 21g

al! purpose flour, saltines, etc.) ete orto | Ft 21 8! 2 rosa Teens
~54 015 | Dairy and Bakery Products toro !
(Indicate if milk is delivered) toro \
Lt !
A vos ds 1
8 | Boe H
€ Bo
D Boe
E Poe
a wo te
g zope
H voit A
f ah |
K PoP
Maat, Fish, and Poultry (Indicote the cut of meat) To. I
L moo if ds 1
m Pe
N 2 3 4 '
5 Pop
a mot
& ma
5 ? 14 i
T m3 (4 i
v out i
=~ 54 023 Fults and Vegetables (Indicate if dried) 1
A 2 Is !
8 i ie i
c a : 14 |
0 Far
g Pr
F 2 13 14 I
6 a aos
H Poe |
1 zor
K Pe
Sores 7 4
L Po tf fs i
M PoP i
N — eB i
ig Boe H
a pop !
8 PF |
~54 031 | aus other Faods
a
3 as
¢ eB
D 2 pot !
E - ze
F FP
c Foe
i ay
2 = ops
c Fee |
c pb oF
ri pope
fo aay
P EE l
a fof e

FORM CE+108 (4-53-73)



Page 7

SECOND DAY ie
MPc
MEALS AND SNACKS PURCHASED AT A RESTAURANT, CARRY-OUT, ETC.
OFFICE Item Was this purchased at a - Total cost

USE (Mark one)

ONLY (Include breakfosts, dinners, schoo! lunches, 1 T j T (Include
snacks, and drinks purchosed af o restouront, ( Drive-in | ips.
sane vending mochine, ere) Restaur 1 Cate 1 or | endi"e | Omer

~ 32 045 ! 1caniyrout 1 Dollars Cents
i H 1 ii t
f] 1 1
A 1 2 H 3 * a $ H
7
B : 2 ! 3 “ i fl
c ’ H 2 nm 3 _ n Ha H
T
D 1 H 2 ' 3 Hl 4 Cb Hl
ALL OTHER PURCHASES AND EXPENSES
Total cost Total cost
one lem (Exclude one Stem (Exclude
ONLY (Describe the item purchased) sales tox) ONLY (Describe the item purchased) sales tax)
Collars {Cents Ooilars_|Cents

t
~ 22 053 |cieaning, Laundry Supplies, 1 ~ 22 087 | Housewares, Furnishings, Hardware, '
and Paper Products i I (mirrors, light bulbs, nails, etc.) '
A $ Hl A $ H
8 i__|6 H
c 1 G 1
D t E i
E ! E i
F t F :
G 1 Gy (
1 i
eee ty a center Secrlos ! Tobacco and Smoking Supplies
H $ 1 H s 1
J ( 3 1
K ‘ K 1
~ Personal Care, Drugs, and ' ~ Gas, Oll, Tolts, Parking Fe '

22 061 \yeaieal Supptios ( 22 095 | ont otmer Vehicle Expenses,” 1

(Indicate if prescribed by a doctor) ! Public Transportation Expanses i
T
A $ am A s t
8 18 t
Cc Hl c ‘
T = Tothing, Shoes, Jewelry, and Linens y
D 7 32 102 (such as dress shirts, work shirts, :
E { casual slacks, etc.) H
F H D s t
6 ; i E i
H H F 1
J i G H
Laundry and Diaper Service, L Rent, Utilities, Fuel, Phone, Insurance H
Beauty and Barber Shop, H (Specify period covered by expense, H
Household Help, Babysitters I such as week, month, year) > (
K $ I H s i
L 1 5 Hl
M 1 K 1
N i L i
P ! ~ 22.11) Jotner Purchases and Expenses '
Q i (toys, hobbies, contributions, etc.) (
R ~ ‘ M $ Hl
Movies, Plays, Other Entertainment, ' N H
Club and Other Membership Dues rT Pp 1
i - t
s $ i _je! \
T \ R
u H s H
GIFTS
OFFICE Yas this purchased
USE Item for a member o Total cost
ONLY this household? (Exclude
(Describe the item purchosed) (Mark one) sales tax)
~ 32078 Yes | No | Dollars [Cents
I {
A 4 (2 5 i A
B ' id i
G ! (2 i
D 1 12 H

FORM CE-108 (4-3-73)


Page 6

SECOND DAY

ENTER

DAY

Note: If you need additional space for any category, use pages 18 and 19.

FOOD AND BEVERAGES
OFFICE Hem Mute Net weight loth safe ong) | Total cost
ony (Describe the item purchased, such os bottles, | volume pet unit igi Bi Soles ee)
whole milk, T-bone steak, dried pricots, | packages, | (Exomales: Si 81 gig
olf pumpose flour, soltines, etc.) ete, Sie gt cle! &! 2 tone Tome

~52 019 |b ‘Products ( 1 i :
(Indicate if milk is delivered) 1; fof \

4 a_i rn 1

A _ vow oa as f

B YT 42 43 4

| T2348 r

5 i
\ 1 i L 1

E | ee \
F _| Yt L
G ahs H
H Poe t
J mee ft 1
K eet H
Meat, Fish, and Poultry (Indicote the cut of meat) Toto t

u ‘ ig ye 14 [gs i
M t 72 \3 4 H
N i ig 13 7 t
P + 12 13 ia !
1 L i i

Q ere os (
R + 2 fa Ta H
s Too iA 1
7 7 Tats te H
U Toast
~52 027 | cuits and Vegetables (Iadicare i dried) | |
A * 1 12 13 \4 $ !
a Te
c ae !
D PoP f
E TP Po i
F Te of | i
G a ro 13 14 '
Hl | Fa 1
; ee ee ee i
K ree H
Beverages ; tot H

u "PR? Bp fs i
xm ~ — Ts 8 1
N 1 2 3 i4 1
> — Tee
Q Tea t
2 ek
—1— t

~ 52 035 | aut other Foods toto H
1 1 t i)

A Ve 7 ds !
8 Pe i
c en eee t
D a f
E a ae i
F ei H
G a a t
i a i
) ‘poe H
K a) t 2B u Hl
L eo i
M 1 @ t \4 H
N 1 2 \4 |
P 1 2 ia t
a 1 L if H

FORM CE-108 (4-3-78)



Page 19

ADDITIONAL PAGE

—-
MEALS AND SNACKS PURCHASED AT A RESTAURANT, CARRY-OUT, ETC.
Was th reha at —
OFFICE fem Was is purchased Total cost
USE (Include breakfosts, dinners, school lunches, | - : (include
ONLY Day | snacks, and drinks purchased of o restaurant, i Drive-in! H tips)
bar, vending machine, etc.) Restau- | Cate : Nenging Other
~ 48 041 ; \eatny-out : Dollars (Cents
L — L — —
A 7 1 j 2 \ 3 ! 4 is s '
r Y . *
B 0 z 5 ve 3
C a_i ry Va Is ;
D | Y 12 iu zy 18 mm
ALL OTHER PURCHASES AND EXPENSES
T Total cost Total cost
one Day ttem (Exelude ore Day Item (Exclude
ONLY (Describe the item purchosed) |_S2/@s tx) POE, (Describe the item purchased) |__S2¢s fox)
Dollars [Cents| | Dollars } Cents
~ 38 059 Cleaning, Laundry Suppiles, H ~ 38 083 Housew Furnishings, Hard-| 1
and Paper Products { ware, and Garden Suppfies !
H (mirrors, light buibs, nails, etc.) 4
A ‘| s+ fa | st
B i B [ T
c i c LC i
D i D I
E I E i
+ :
F F |
6 | |e i
’ 1
ationery, and School Supaltas 1 Tobacco and Smoking Supplies !
L L
1 i
H $ L Hy $ H
4 i Jj Hl
T
k Te -
~ 38 067 f] i ~ 38 091 "Gas, Oll, Tolls, Parking Fi i
6 arian Care, Drugs, and H and Other Vehicle Expans: '
I Public Transportation Expenses I
A i $ i A ; °
B {sf 8 L i
c 1 |e ' i
D 1 ~ Clothing, Shoes, Jewelry, and
48 108 Linens {Such as dtess shirts, i
E ( work shirts, casual stacks, etc.) 1
F ! D 8 i
: + :
6 : E [
1
H \ F LL
3 Lot G LL
Eauadry and Diaper Serve, H Rent, Utliitles, Fuel, Phone, H
if rbar Shop, 1 Insurance (Specify period I
| Housshold Help, Babysitters ( covered by expense such as \
% ry T week, month, year) '
L H H | $ T
t i: ,
M 1 J 1
N H K sf H
P 1 ~ Other Purchases and 1
38 7 Expenses (toys, hobbies, 1
Q | contributions, etc.) l
R f TM 5 i
Movies, Plays, Other ! N '
ntertalnment, Club ani ral
Other Membership Dues L P| [| !
{
s s Hl Q a
T i R \
LI H
GIFTS
OFFICE tt Mas this wichased Total cost
USE em ! Exclud
this household? | (Exclude
ONLY Day (Describe the item purchased) a role sales tax)
~ 48 074 Yes | No |Doliats !Cents
7 t : 4
1
A ‘ 2 $ i
B 1 { 2 t
Cc 7 la }
T :
[p ' 1 2 L

worm cmciOn (4encTad


Page 9

THIRD DAY oe
mec
MEALS AND SNACKS PURCHASED AT A RESTAURANT, CARRY-OUT, ETC.
OFFICE Item Was this purchased at 3 - Total cost
(Mark ane)
onty {Include breckfosts, dinpers, school lunches, 7 _" i 1 (Include
snacks, and drinks purchased of a restauront, Drive-in snp | tips
bor, vending machine, efc. Restav- 1 Cafer | i Vending Other
~ 33 043 rant 1 BV eay out! machine |
' 1 \ ! Doltars 1 Cents|
. 1 t 1 aS 1 H
12 15
A ‘ n fi i i $ L
B 5 Ura 13 14 (s '
itt —
c _ ' H 2 B “ ih t
1 12 3 Ta 1S 1
D 1 CL 1 ! 1
ALL OTHER PURCHASES AND EXPENSES
Total cost Total cost
OFFICE
Use item (Exclude one Stem (Exclude
ONLY (Describe the item purchased) sales tex) ONLY (Describe the item purchased) sales fox)
Dollars jCents Dollars _|Cents|
~ 23 051 |e i ~ 23 085 | Housewares, Furnishings, Hardware, y
leaning, Laundry Suppites, H and Garden Supplies ot
i (mirrors, light bulbs, nails, etc.) i
A s H A $ i
B 1 |B i
c { ¢ i
D i > Hi
E i E i
F i F |
G 1 & i
Newspapers, Books, Poslage, Y 1
Stallonery, and School Supplies t Tobacco and Smoking Supplies t
H § i Ht 5 i
4 , _
K H K _
~ Personal Care, Drugs, and 1 ~ Gas, Oll, Tol y fl
23 069 | yedicai Supplies i \ 23.093 | tomer Vehicle eeneetee !
(indicate if prescribed by a doctor) H Public Transportation Expenses !
A 8 H A $ H
8 _ {8 1
c t c |
— T ~ Tlothing, Shoes, Jewelry, and Linens T
2 ! 33.100 | (sich as dress shirts, work shirts, !
E H casual slacks, etc.) H
T T
F 1 D $ f
T T
G ( E 1
T T
H 1 F i
3 1__|e¢ 7”
Laundry and Dlapes Service, Hl Renl, Utilltles, Fuel, Phone, Insurance |.
Beauly and Barber Shon, { (Specify period covered by expense, :
Household Help, Babysitters - 1 such as week, month, year) mm 2 1
K $ Hl H s 1
u \ J 1
M i K 1
N i L 1
Pp H ~ 23119 | other Purchases and Expenses '
Q ' (toys, hobbies, contributions, etc.) 1
R t | $ fl
Movlas, Plays, Other Entertainment, \ N —_
Club and Other Membership Dues Hl P 1
—_
s | fe i
T ' R t
4
A s H
GIFTS
OFFICE flas this urchased Total cost
USE Item of 3 member af
ONLY this household (Exclude
(Describe the item purchased) (Mark one) soles tox)
~ 33076 ves | No Dollars }Cents
1 1
A ‘ 2 $ H A
B i? i
c Te "
1 2
D H 1

FORM CE-308 (4-3-73)


(hein
O.M.B. No, 41-S72032; Approval Expires December 31, 1974

FORM CE-105
(4-3-78)

U.S. DEPARTMENT OF COMMERCE
SOCIAL AND ECONOMIC STATISTICS ADMINISTRATION
BUREAU OF THE CENSUS
ACTING AS COLLECTING AGENT FOR
U.S. DEPARTMENT OF LA80R
BUREAU OF LABOR STATISTICS

RECORD OF YOUR DAILY EXPENSES

NOTICE — All information which would permit identification of the
individual will be held in strict confidence, will be used only by persons

engaged in and for the purpases of the survey, and wil! not be disclosed
or released to others for any purposes.

Day Date
FROM
THROUGH
Area Office Sample week 73
_
~91017 OFFICE USE ONLY PROCESSING USE ONLY
1. Control number 2. HH No./3. CUNo.|4, Diary |5. Starting | 6. Extra |7. 8. PLC
PSU ' Sample jSerial Ick Dig, ] day units
l ( ' 2
1 i 1
1 1 n



Page 12

FIFTH DAY

ENTER
DAY

Note: if you need additional space for any category, use pages 18 and 19.

FOOD AND BEVERAGES
OFFICE Item Number we yen hath ealy ene) Total cost
USE (Describe the item purchased, such as bottles, | volume per unit re: gl (Exclude |
ONLY whole milk, T-bone steak, dried apricors, | packages, | LE xomales: gi Ri gig
all purpose flour, saltines, etc.) ele, 5 Ibs, eve.) &} | 3) 8] dona i cents
~55 012 | Dalry and Bakery Products rt i
(Indicate if milk is delivered) hoy 4 I
- Ht
B 7 2 fg ie
¢ | pe oP !
D Peo |
E ef i
F Peo f
c . rae ee t
H Te oo t
ri ree
K "PB i
‘oat, Fish, and Poultry (indicate the cut of meat) roto i
L 1 12 13 18 Ig 1
M meee L
N ye L.

P re pF
Q re eo f
R Poi I
5 a I
T vo 4 i
U To +
~55 020 | cutts and Vegotables (ipdicate if dried)
ee a
B Ta 38 i
— 1 1 1 L
c Pe Pt |
D roe ot
E cP Pp i
F roy pea i
6 eee :
1" TPF
J 1 ie ia iS Hl
K 1 a 8 iS '
Beverages if I i f
L vPro | fs 1
vy Teo (
N | ee t
P i 1 e 8 i i
3 Te

R Fe LL

—1—

~ 55 038 | au other Foods ,otot
4 1 1 1
x Th Bh fg t
B ee i
c oe i
D re H
E _. Ye it |
F TE
G i 1 2 ‘3 14 |
i ; 1 2 3
J vo ak |
K PF |
L 1 eo te }
M 1 2 3 \4 Hl
N 1 \2 \3 4 i
P 72 3
Q 1 ? 3 if I

FORM CE-103 (4-$-73)



Page II

FOURTH DAY ee.
ope
MEALS AND SNACKS PURCHASED AT A RESTAURANT, CARRY-OUT, ETC.
OFFICE lem Was this purchased at a — Total cost
USE (ork one)
(include breakfasts, dinners, schoo! lvaches, ; 7 (Include
ONLY snocks, and drinks purchased at a restauront, Restau- | Cafe: ' Orive-i0) Vonging | tips)
ber, vending machine, etc.) festau- 1 Cafe o =! 2! Other
~ 34 041 rant 1 tena teat’ out! I machine |
! (earn \ 1 Dollars Cents
1 (2 13 ry '
A 1 L 1 n §
T z 3 a 13 1
8 n 1 ! L L
1 12 ia 15 1
, m8 r 1 t
1 1
D 1 _ 1 1 1
ALL OTHER PURCHASES AND EXPENSES
r
Total cost Total cost
E
one tem ‘Exclude | OFFICE item (Exclude
ONLY (Describe the item purchased) sales tox) ony (Describe the item purchased)  |_S#/es tax)
Dollars jCents |_Dollars {Cents|
~ 24 059 H ~ 24 083 | Housewares, Furnishings, Hardware, H
lesan, Lamar Snel, and GaraenSupien
i (mirrors, light bulbs, naits, etc.) I
A $ i A ; T
B T B T
G I c i
D i D i
E i E 1
— T
F \ F | i
G 1 G '
t I
Pianist To ! Tobacco and Smoking Supplies ‘
4 $ i H $ i
J ( J H
K ! K ‘
~ Personal Care, Drugs, and 1 ~ Gas, Oll, Tolls, Parking Fees, 1
24 067 | edleal Supplies ' 24 O97 | ona ‘otner Vetlicie Exnens i
(Indicate if prescribed by o doctor) 7 Public Transportation Expenses H
! i)
A $ LL A s n
8 , |e ! . A
c ' c i '
T ~ Clothing, Shoes, Jewelry, and Linens T
- 1 34 108 (such as dress shirts, work shirts, !
E i Casual slacks, etc.) '
F H . TT $ Hl
G 1 ie 1
H r F
J H 6 H
Laundry and Diaper Service, T Rent, UUllitles, Fuel, Phone, Insurance 1
Beauty and Barber Shop, { (Specify peried covered by expense, i
Household Help, Babysitters \ such as week, month, yeor) —y 1
K $ i H $ i
L 1 3 {
M \ K i
N i L 1
P t ~ 24 117 | other Purchases and Expenses i
Q 1 (toys, hobbies, contributions, etc.) 1
L
R | t M is fl
Movies, Plays, Other Entertainment, H N t
Club and Othet Membership Dues I P t
L H
1
s $ I Q H
( 1
T L R L
uv H 8
GIFTS
OFFICE as Ihis purchased fl
USE tte esiNeaber Total cost
ONLY m this household? (Exclude
(Describe the item purchased) (Mark one) soles tax)
~ 34 074 Yes | No | Dollis {Cents
t 1
A ‘ a i A
B Te i
¢ 5 12 i
1 mr} T
D if i



Page 8

THIRD DAY ‘DAY
DAY
Note: (f you need additional space for any categoty, use pages 18 and 19.
FOOD AND BEVERAGES
Number Nel weight Is this item -
OFFICE Item of cans, or (Mork only ane) Ly in
USE (Describe the item purchased, such as bottles, | volume pet unst tel gt Soles tox)
ONLY whole milk, Fbone steok, dried opricots, —_| packages, {Exomples: Bi 81 gis
ff i . , oz., | agt., 21 oy 1é r
all purpose flour, saltines, etc.) etc. 5 lbs, ered =, = | S; G| dotlars | Cents
~ 53 017 | Dairy and Bakery Products i . - 1 y 1 i
(Indicate if milk Is delivered) torot |
ity !
A Y (2 13 14 5 I
t 2 3 a!
B { - i 1 : 1
t \
c | Lo 1
1 42 3 14 \
D 4 i in i
\ 1 1
E Pee \
7 Ie 3 V6 1
F | ie
G H 1 \2 13 ‘a |
t a T T
‘ aa
J TF i“ 1
13 T
K ' i2 i: if I
Meat, Fish, and Poultry (Indicate the cut of meot) a i
L . vo ie Is \
” vo yz ya 4 i
T2138 i
N 1 1 4 in
a '
; pt
ZI
Q ' ? 3 44 I
rare T
R 1? 3 af 1
Ss , 72 73 4 H
T Te oP
v 7 2 43 48 4
~ ir ey — * - 4 ' 7 !
53025 | erates arid Vegetables (indicate if-dried) | H H H
A 2? | t
1
72-413 16 1
8 | 14 1
c rr }
eo !
D Dy 2 13 io ;
i
E oP i
F ro ya 4 i
tC T1238 ;
7 ry 12 3 14 H
so
5 i? f
jor H
t 2 13 14 t
K ——t t
Beverages . 1 IL 1 1
+ T T T
L | ' 2? 7 i |s 1
M r 2 | |4 Hl
“ +23 ta i
Toy
P 7 — i rm |
214 1
Q L 1 Ll n
I 1
R 1 1 H ;
———
= 53 033 | aii other Foods roto f
1 1 1 1
A EB ds H
B 1 2 3 14 :
1 1 L L
Cc 1 te 3 ‘4 !
D : cee !
— 142 emery j
j ot
FE a j
1
s eo
H 1 2 13 14 i
bot
J 1 \2 18 “ |
K Toe |
eee
M 1 12 13 14 |
Lt
1 12 13 14 !
N 1. 1 1 1
Ea) 1
P L 1 1 1
a 12 13 14 1
Q 1 1 L L

FORM CE-105 (4-3-73)



Page 4

;

FIRST DAY

ENTER
DAY

Note: If you need additional space for any category, use pages 18 and 19.
FOOD AND BEVERAGES
OFFICE ttem Naber Net werent ert cree) Total cost
USE (Describe the item purchased, such as bottles, | volune per unit ist 31 (Exclude
ONLY whole milk, T-bone steak, dried epricots, ) packages, | (Examales: S181 gi 3
all purpose flour, soltines, ete.) : 5 lbs, ere) ii i | S) 5 Monae scents
~51 011 | Dalry and Bakery Products , 1 7
{Indicote f milk ts delivered) | 1
aot
. _? a +z r
c a !
D 1 \2 ' 3 Hl 4 t
E r 13 ta
F voi as 1
G : i
H |
nl _ t
us H
Meat, Fish, and Poultry (Indicate the cut of meat) i
L 1
v1 i
N 1
P \
Q I
R H
A i
T i
u H
~51 029 | eruits and Vegetables (indicate if dried) '
A i
8 H
c \
2 1
E H
; |
cS H
H H
J i Le
K H
Baverages i
L
M j
N
> _ i
a i
.
~ 51 037} ai other Foods |
A
[a L
c - i
2 H
£ |
F LL
6 j
H :
J L
K 1
L LL
M i
R L
P H
a H



Page 1S

SIXTH DAY are.
copec
MEALS AND SNACKS PURCHASED AT A RESTAURANT, CARRY-OUT, ETC.
q 2 =
OFFICE item Was this Burch sed at a Total cost
USE é erk one) Unclod
ONLY (include breokfasts, dinners, school lunches, i r H T elude
. 1 | . i) a
grecke, grains orchegsd ov 2 recur, | resins | cates {PGE | vening| oe
~ 36 046 ! eary-outy ' Dollars TCents
L fs i= 41 i
rn 7 % iF) rs 5 ; 1
L —L —l J 4
B U ry 12 Ta ts '
1 == 1 i 1
c 7 2 n vy 1S r
po
1 4
D ss L
ALL OTHER PURCHASES AND EXPENSES
Total cost Total cost
oe Hen (Exclude | OFFICE Nea (Exclude
ONLY (Describe the item purchosed) | sales tox) | 16 (Describe the stem purchased) sales tox)
Dollars |Cents Dollars Cents
5 t i
~_ 26 054 | cleaning, Laundry Suppties, t ~ 26 088 Housewares, Furnishings, Hardware,
and Paper Praducts f {micrors, light bulbs, nails, etc.) |
A i A $ i
T tT
B 1 [8 TL
c Hl c H
D oe i
E i E 1
F i F ,
r ~
G 1 co] LL i
Newspapers, Books, Postage, \ ; '
Stationery, and School Suppiles ' Tobacco and Smoking Supplies '
H t H $ 1
J ' 5) '
K 1 K 1
~~ Personat Care, Drugs, and N ~ Gas, Oil, Tolls, Parking Fees, '
26 062 Medical Supplies . ! 26 096 and Other Vehicie Expenses; '
(ndicote if prescribed by a doctor) Public Transportation Expenses '
I t
A L A s a
B L 8 ql
c i ig 1
T ~_ Tothing, Shoes, Jewelry, and Linens T
° | __} ~ 36 103 J (euch as dress shirts, work shirts, H
E i casual slacks, etc.) it
F H D $ Hl
G H E H
HH i F t
[a i__|s L H
Laundry and Diaper Service, 13 Rent, Utititles, Fuef, Phone, Insurance yo
Beauty and Barbar Shop, I (Spacify period covered by expense, i
Household Help, Babysitters i such as week, month, year) > \
K 1 H l $ i
C Th 7
M t K i
N L 1
P ! ~ 26 112 | other Purchases and Expenses \
la 1 (toys, hobbies, contributions, etc.) 1
R ’ ” I $ j
Movies, Plays, Other Entertainment, ! N _ !
Club and Other Membershjp Dues t P t
H ‘
1
Ss t @ \
1
T L R |
L_ Ls 1
GIFTS
OFFICE jas this purchased
USE ttem of a member of Total cost
ONLY this household? (Exclude
(Describe the item purchosed) (Mark one) soles tox)
~ 36.079 Yes | No | Dollars {Cents .
1 1
1 12 T
A ! $ 1 »
8 ' ft i
¢ ! 12 rf
D ' 2 i

FORM CE-108 (4-3-73)


Page 17

SEVENTH DAY eo
mec,
MEALS AND SNACKS PURCHASED AT A RESTAURANT, CARRY-OUT, ETC.
OFFICE tem Was this purchased at a ~ Tolal cost
USE (Mark one)
ONLY (Include breakfasts, dinners, schoo! lunches, T T 1 r (Ine luce
f - :
sorted needy eeu Trew | ate (OME vente! ones |?
~ 37 044 1 iearyrouty ' Dollars 1Cents
: ih : 1 “| H
t
A 1 H 2 \3 H 4 ° $ H
B 1 12 3 ry is 1
at
1
Cc 1 i 2 i ih t
12 a Ss i}
D ' 1 j \ 1 L
ALL OTHER PURCHASES AND EXPENSES
Total cost Total cost
oe item | (Exclude | OFFICE Item (Exclude
ONLY (Describe the item purchased) soles tx) onty (Describe the item purchased) soles tox)
Dollars (Cents| Dollars {Cents}
~ 27 052 ! ~ 27 086 | Housewares, Furnishings, Hardware, i
Chea Lainay Sines wer tartan eevee
OE Lerets: ist H (mirrors, light bulbs nails, etc.) !
A H A $ T
B H B H
¢ i fe i
D i [p 1
E i E 7
7” t
F i F \
G 1 & \
——~— ‘ - 1
Her searrte orga aac ti ! Tobacco and Smoking Supplies !
H ! H $ {
J ! J (
K i K i
~ Personal Care, Drugs, and i ~ Gas, Ol, Tolls, Parking F i
27 060 Medical Supplies k 1 2 8A et other Vehicle Expenses; t
(ledicate if prescribed by'o'doctor) H Public Transportation Expenses {
1
A A $ i
Y
B B L
¢c Hl c !
T ~ Clothing, Shoes, Jewelry, and Linens t
° { 37101 (such as dress Shirts, work shirts, !
E i casual slacks, etc.) H
F { D is i
G ( E 1
H H F T
J i 6 H
Laundry and Diaper Service, Rant, Utilities, Fuel, Phone, insurance I
Beauty and Barber. Shop, i (Specify period covered by expense, {
Household Help, Babysitters 1 such as week, month, year) —y i
K 1 |r s i
u 1 J i
M 1 K t
N , L | i
P : ~ 27110 | other Purchases and Expenses © i
Q i (toys, habbies, contributions, etc.) 1
z] __|¥ a
Movies, Plays, Other Entertainment,” i N H
Club and Other Membership Dues | P 1
1 _ L
s 1 fa {
1 ir \
u j $ t
GIFTS
OFFICE Was this purchased
USE tem for a ment ela Tatal cost
ONLY this househo! (Exclude
(Describe the item purchased) (Mark one) sales tox)
~ 37077 Yes | No | Doilars !Cents
1 1
A ' 12 3 i A
8 ' 2 i
¢ re i
D ' 2 i
i

FORM CE-106 (4-93-73)



PP Please provide the following information when recording purchases of these items:

FOOD AND BEVERAGES
Milk -— Specify if whole, skim, half and half, chocolate, condensed, etc.
Cheese — Specify if solid cheese, cheese spread, or cheese dip.

Bread — Specify if white, whole-wheat, rye, pumpernickel, etc.

Beef — Specify the cut and describe, such as round steak, sirlain steak, ground beef, prime ribs, etc.
Pork — Specify the cut and describe, such as loin roast, fresh whole ham. spareribs, bacon, etc.
Chicken ~ Specify sf fryer, broiler, parts (sold separately) or other chicken.
Soft Drinks — Specify if cola or other type. If not cola, specify if carbonated or noncarbonated.
Coffee — Specify if instant or ground: if ground, indicate if in bags or cans,

Teo — Specify if instant, tea bags, or loose.

Sugar — Specify if white, brown, granulated, confectioners’, or powdered.
Cereal — Specify type (corn flakes) or brand name.
Flour — Specify if white, all purpose, cake, whole-wheat or other flour.

Page 3

DETERGENTS — Specify if for jaundry, household cleaning, or dishwasher and if liquid or powder.
DOCTOR BILLS — Specify type of doctor visited, such as general practitioner, internist, etc.
DENTIST BILLS — Specify the type of work, such as extractions, teeth straightening, etc.

TOYS — Specify, such as games. electric train set, doll, etc.

D> EXAMPLES OF SOME FOOD ITEMS

FOOD AND BEVERAGES
Number Net weight Is this item -

OFFICE lem af cans, or (Mork only one) Tole! cost
USE (Describe the item purchased, such os bottles, ; volume per unit | 2 Tg. gl soles 10x)
ONLY whole mitk, T-bone steok, dried apricots, packages, i fExamples: ;erke g ' 3

oll purpose Nour, seltines, #12. ac. Ses ete) By | S| & Ootae Cems
11 | Dairy and Bakery Products yor \
SO indicate if milk is delivered) toad '
a H
A Mlk ~ tha. 2 Pow? 13 14 [s \ 59
B LoClage. cheese. WA “xi L Lor
| Ades. ‘xe Lox
c gle t dy tz rm zy t
Meat, Fish, and Poultry (Indicate the cut of meat) i I r
L Beeg. pot nopsl” Bese x" |s vw xe
M Chichi parte oe | Ex cr
N Pork ckope / Ste xP? ov LL
‘i lire ee |
TT 1
5) 029 | cruits and Vegetables (Indicote if dried) ! ! ! !
Bberpocte 2 (doy |\ es |s \£F
torte 7 pent X81 a9
t a ]
MEALS AND SNACKS PURCHASED AT A RESTAURANT, CARRY-OUT, ETC.

OFFICE Item Wes rae aa Tolai cost
USE (Include breakfasts, dinners, schoo! lunches, ~ ne T (ne lude

ONLY geacks, and drinks ‘purchased of @ restaurant, Restau- | cate | Drive-in |Vening| otter ip

~ 3) 047 ‘ Tank 1 ANE feaneyout MAEM Dollars _1Cents
1 ! ! 1
1 H 1 t H
A Lurch i a s 2.137
8 Cofhee ' Booey Wrst
c a sehood Luncheon 1 eK I Va 5 \90
. 1 12 13 Ta ry 1
> EXAMPLES OF SOME OTHER DAILY ENTRIES
ALL OTHER PURCHASES AND EXPENSES
Total cost ] Total cost
oe Hem (Exclude ormcé tem (Exclude

ONLY (Deseribe the item purchased) soles tox) oucy (Describe the item purchased) soles tox)

Doilars_|Cents| Doliars |Cents|
' ~ , Furnishings, Hardware, !
~ 21 055 | cleaning, Laundry ‘Supplies, 1 21 089 | Housewares, Furnishings, Hardware
and Paper Products i (mirrors, light bulbs, nails, etc.) t
1

A Way pepre s 1a [A WactebatheL 3 |e

T ;

B pee. 199 |B fulto ‘Pp?
E Hig. Leserclry datingat | 147 [8 ZigAt
=o |e | om [ee ah armen |
Undicate if prescribed by 0 doctor) ' Public Transportation Expenses !

A Abpirin s Leg]A Hadrhnre $ igs
iy t

8 ALeeray, Athol ,_& 190 |8 Gace Lee
c ' ! c !



Page 2

INSTRUCTIONS

> GENERAL INFORMATION

This form is for recording ALL your expenses for a 7-day period. Beginning on page 4 there are two facing
pages for each day. Record each day's expenses on the appropriate pages. Enter the day in the heading as
shown below:

r

_FIRSTDAY [EN ay

D> WHAT TO REPORT

Record ALL purchases and other expenses of the persons shown in the box below during the period
indicated on the cover.

Include purchases and expenses of — “| ALL members of this household

All of the following persons
oa 7

Include - Every purchase or expense, no matter how smail or inexpensive it is.
The FULL cost of gasoline, clothing, and other items purchased by cash or on credit during the period.
Costs for all snacks, beverages, and meals purchased at restaurants, carry-outs, etc.
Expenses for such things as entertainment, public transportation, babysitters, and contributions.
ALL bills PAID during the period for recurring expenses such as rent, mortgage, and insurance.

Do oot include - The expenses of persons while they were away from hame overnight.

Credit or installment plan PAYMENTS, such as store revolving charge accounts, payments to
finance companies, Diners Ciub, BankAmericard, Master Charge, etc.

Business or farm operating expenses.
Sales tax in the cost of the item.

> How TO REPORT

For some food items, certain information in the description of the item is needed in order to select the appropriate
item to price in the stores. These items and the information needed are listed on the opposite page. ———_-»
Please refer to the list when recording any of these items.

Also shown on the opposite page are a few examples of recorded expenses. It will be helpful to look at these
examples before recording your expenses. If a food or beverage item is not fresh, frozen, or canned, mark
the ‘‘Other'' box.

D> WHERE TO RECORD EXPENSES
Enter all purchases and other expenses in the correct category on the page for the appropriate day. Record
gifts purchased in the ‘‘Gift’’ section. Two pages are provided for each day's expenses.

\f there is not enough space to record all expenses of a particular day on the lines provided, enter the
additional items on pages 18 and |9. BE SURE to specify the day on which the expenses occurred in the
column headed 'Day."*

{f you do not know where to enter a food item, enter it in the ‘‘All Other Foods’’ category.

\f you cannot determine where to enter any other item, enter ic in the ‘‘Other Purchases and Expenses’ category.

> BEST TIME TO RECORD
Most peopie find that keeping the diary is easiest if they RECORD THEIR PURCHASES AS SOON AS THEY
GET HOME FROM THE STORE.

For recurring expenses such as rent, mortgage payments, utility bills, and other bills such as for doctor,
hospital, or dental services, record the amount of the expense on the day the bill is paid.

Each day the diary keeper should check with other household members for their expenditures during that day.
Also check the Daily Reminder List on the back cover for any expenses you may have forgotten to record.

> ANY QUESTIONS?

(will be back on
the meantime, please call me.

to pick up your completed diary. If you have any questions in

Interviewers name Telephone — Area code and number

FORM CE-105 14-9-73)


Page 13

FIFTH DAY HP.
mec
MEALS AND SNACKS PURCHASED AT A RESTAURANT, CARRY-OUT, ETC.
Was this purchased at a —
OFFICE
ee Item (Mork one) Total cost
ONLY (Include breakfasts, dinners, schoo! lunches, T T r T Unehude
snacks, and drinks purchased at o restaurant, | Drive-in ' ips
bor, vending machine, etc.) Restau- «Cafe {Wendin | Other
~ 35 048 ! yeatty- ots 1 Dollars {Cents|
‘ 1 ! { 1 H
1
A 1 \- ! 3 4 { Ey $ H
2 a 1
8 a a
Cc 1 t 2 in fe t
’ 12 3 1s I
D 1 1 t L L
ALL OTHER PURCHASES AND EXPENSES
Total cost Total cost
orice tem (Exclude oneee Item (Exclude
ONLY {Describe the item purchosed) soles tox) onty (Describe the item purchased) sales tox)
Dollars _;Cents| Dollars Cents)
~ 25 056 t ~ 25 080 | Housewares, Furnishings, Hardware, ‘
Cleacing, moe { and Garéan Supplias {
1p + (micrors,.tight bulbs; nails,.etc.) i
A s { A $ Hi
T
8 i |B H
c i__|e | 1
D i |e i
E H E i
F i F Hl
G i c i
| ; "
Senay faa eenser sunettse i . Tobatco and Smoking Supplies: i
H s 1 H $ H
J i 5) H
K ! K ‘
~ Personal Care, Drugs, and | 1 ~ Gas, Dil, Tolls, Parkl '
25 064 | usaieal Supplies t 2 98 | ot gtnes- Veni king f )
(Indicate if prescribed by e doctor) t Pubilc Transportation Expenses !
A s H A $ H
¢
8 eC 1
c t c Hl
D ae ra Clothing, Shoes, Jewelry, and Linens r
1 35 105 | (such as dress shirts, work shirts, . !
E I casual slacks, etc.) H
T
F ia , D $ 1
G ! 1 E t
T
H i i F H
J i G H
Laundry and Dlaper Service, ae Rent, Utilities, Fuel; Phone, Insurance 4]
Beauty and Barber Shop, i (Specify period covered by expense, H
Household Help, Babysitters 1 : suchas week, month, yeor) 1
K $ i a $ i
L 1 J i
M i K i
N ' L 1
P ! ~ 25 114 | other Purchases and Expenses I
Q i 1 (loys, hobbies, contributions, etc.) \
R | |s s H
Movies! Plays, Ottier Entertainment, t N H
Club and other Membership Dues t P !
1 L
s ,__|¢@ i
1
T H R 1
U t $ \
GIFTS
OFFICE Was this purchased
Use tem fora mem etal Total cost
ONLY this househo! (Exclude
(Describe the item purchased) (Mark one) soles tox)
~ 35071 Yes | No | Dollars {Cents|..
A ' ? 3 1 A
B ' e i
c 1 mG i
D 7 ig T '

FORM CE-108 (4-3-731


Page 16

SEVENTH DAY

ENTER
DAY

Note: If you need additional space for any category, use pages 18 and 19.

FOOD AND BEVERAGES
OFFICE em Nunoet Net werent tens ee Tolal cost
one (Describe the item purchosed, such os bottles, | velume per unit Tot gt (Exclude
NLY whole milk, T-bone steok, dried apricots, | packages, | (Exomales: Gi 81 2i 5

all purpose flour, soltines, etc.) etc. Sto, er) [2 | & | S| Sl Gonars iGents
~ 57 018 pay and Baker Products ! ! f !
Indicate if milk is delivered) hor I
n Le
B y 2.34 7
ne i
c Pe |
D 1 12 3 if H
E - 1 2 2 it t
F 1 12 ha (4 t
G 1 12 C i“ !
4 Tee
J vo 12 3 v4 | i
rm i a a
Meat, Fish, and Poultry (Indicote the cut of meat) Toto I
Ll Tz 8 1 fs '
mi Ta *
“ pote
| 1
P Tee
Q a :

R 1 te 13 Ta

s fF 3 :
T 1 2 13 4 T
U rr re ce :
~57 026 | erate and Vegetables (Indicate if dried) |
rn Te ss fs
" i aa
c 7 ais 1
D 1 2 3 i“ :
E me po 1
F 1 eta ta H
S a ee !
1" TR
j Te 38 1
x esr 1
Boverages Tort 1
L VP fs i
M Rm 3 4 7
N Te t
e Ti 3 a ;
7 ; 7 i "3 mH j
R eee H
~ 57-034 | a4; other Foods 1
A ETS
B Tet

c 1 2 13 uo H |
D 2 3 8 p
E 7? 3 i
FE 7 2 3 1 1
- ; Te sf
73 1 :
J 1 2 2 " I
K 1 2 2 . j
u ve? 1
x 2 88 ; j
nN Te j
P Tea 1
@ ft fg o \‘ t

FORM CE-108 [4-3-78)