Questionnaire Text

Questionnaire form view entire document:  text  image

During 1979 did this person receive any income from the following sources?

If "yes" to any of the sources below -- How much did this person receive for the entire year?

[Fill the yes or no circle for each part and enter the appropriate amount. If income from any source was received jointly by household members, report if possible, the appropriate share for each person; otherwise, report the whole amount for only one person and mark No for the other person, unless the other person has additional income of the same type.]


32a. Wages, salary, commissions, bonuses, or tips from all jobs

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

[] Yes --

$ ____ .00 (Annual amount -- Dollars)

[] No


[Include sick leave pay. Do not include reimbursement for business expenses and pay "in kind," (for example, food, lodging received as payment for work performed).]