9. Who lives in your home with you? (Tick all that apply)
10. □ No-one else but me
11. □ Other relatives (Number ___)
12. Spouse/partner
13. □ Non-relatives (Number _____)
14. □ Children (Number ___)
10. What suburb do you live in? _____

Please return this form to a Shire representative before the end of the focus group.

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