Answer "yes" or "no" for all sources. If "yes," also enter the amount; in case of a loss, also mark "loss." Do not include Family Allowances and Child Tax Credits. Consult the Guide for details.
(a) Total wages and salaries including commissions, bonuses, tips, etc., before any deductions

[] Yes

Dollars ____ Cents _ _

[] No

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

[] Yes

Dollars ____ Cents _ _

[] No
[] Loss

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

[] Yes

Dollars ____ Cents _ _

[] No
[] Loss

(d) Old Age Security Pension and Guaranteed Income Supplement from federal government only (provincial income supplements should be reported in (g))

[] Yes

Dollars ____ Cents _ _

[] No

(e) Benefits from Canada or Quebec Pension Plan

[] Yes

Dollars ____ Cents _ _

[] No

(f) Benefits from Unemployment Insurance (total benefits before tax deductions)

[] Yes

Dollars ____ Cents _ _

[] No

(g) Other income from government sources including provincial income supplements and grants and social assistance, e.g., veterans' pensions, workers' compensation, welfare payments (do not include Family Allowances and Child Tax Credits)

[] Yes

Dollars ____ Cents _ _

[] No

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

[] Yes

Dollars ____ Cents _ _

[] No
[] Loss

(i) Retirement pensions, superannuation and annuities

[] Yes

Dollars ____ Cents _ _

[] No

(j) Other money income, e.g., alimony, scholarships

[] Yes

Dollars ____ Cents _ _

[] No

(k) Total income from all of the above sources

[] Yes

Dollars ____ Cents _ _

[] No
[] Loss