Questionnaire Text

Questionnaire form view entire document: text image

[Questions 47?48 were asked of all persons.]

47. Income in the past 12months.
Mark (X) the "yes" box for each type of income this person received, and give your best estimate of the total amount during the past 12 months. (Note: The "past 12 months" is the period from today's date one year ago up through today.)

Mark (X) the "no" box to show types of income not received

If net income was a loss, mark the "loss" box.

For income received jointly, report the appropriate share for each person. Or, if that's not possible, report the whole amount for only one person and mark the "no" box for the other person.

a) Wages, salary, commissions, bonuses, or tips from all jobs.

Report amount before deductions for taxes, bonds, dues, or other items

[] Yes

$_ _ _ _ _ _.00 (Total amount for the past 12 months)

[] No

Questionnaire instructions view entire document: text image

48. Add the total entries (subtracting losses) for 47a through 47h for the past 12 months and enter that number in the space provided. Mark the "Loss" box if there is a loss. Print the total amount in dollars.