If yes, please check the "Yes" box and enter the amount; in case of a loss, also check the "toss" box. If no, please check the "No" box and proceed to the next source. Do not include family allowances. Please consult the Guide for details.
a. Total wages and salaries including commissions, bonuses, tips, etc., before any deductions

[] Yes

Amount: _ _ Dollars _ _ Cents

[] No

b. Net non-farm (gross receipts minus expenses) from unincorporated business, professional practice, etc., on own account or in partnership.

[] Yes

Amount: _ _ Dollars _ _ Cents

[] No
[] Loss

c. Net farm self-employment income (gross receipts minus expenses) from agricultural operations on own account

[] Yes

Amount: _ _ Dollars _ _ Cents

[] No
[] Loss

d. Old age security pension and guaranteed from federal government only, income supplement and benefits from Canada or Quebec Pension Plan (Provincial income supplements should be reported in f )

[] Yes

Amount: _ _ Dollars _ _ Cents

[] No

e. Benefits from Unemployment Insurance.

[] Yes

Amount: _ _ Dollars _ _ Cents

[] No

f. Other income from government sources including provincial income supplements and social assistance, e.g., veterans" pensions, workers' compensation, welfare payments (Do not include family allowances)

[] Yes

Amount: _ _ Dollars _ _ Cents

[] No

g. Dividends and interest on bonds, deposits and savings certificates, and other investment income, e.g., net rents from real estate, interest from mortgages

[] Yes

Amount: _ _ Dollars _ _ Cents

[] No
[] Loss

h. Retirement pensions, superannuation and annuities and other money income, e.g., alimony, scholarships (Do not include family allowances)

[] Yes

Amount: _ _ Dollars _ _ Cents

[] No

i. Total income from all of the above sources (Do not include family allowances)

[] Yes

Amount: _ _ Dollars _ _ Cents

[] No
[] Loss