Literal question
<span class="h2">IV. Deaths in past 12 months</span>
<br />[Questions D1-D4.]</p>
<p><span class="em">These questions are to be asked to the head of household, or to his/her representative.</span></p>
<p><svar v="RW02A076">[Questions D1-D4 were asked only if there was a death in the household in the last 12 months]<br /></svar></p>
<p><svar a="all" v="RW02A076">D1. ____ Names<br /><div class="i1">Write down the last names and the first names of all deceased persons during the past 12 months.</div><br /><br />D2. Sex<br /><div class="i1">Circle the number corresponding to the sex of the deceased person.<br /><br />[] 1. Male<br />[] 2. Female</div><br /><br />D3. _ _/ 200_ Date of death (month and year)<br /><div class="i1">Specify in the first two boxes the month of the death, and in the last box the year of the death.</div><br /><br />D4. _ _ _ Age at death<br /><div class="i1">Write down in the empty boxes the age of the deceased person at time of his/her death.</div><br /></svar>