Mark the "Yes" or "No" box for each type of income, and enter the amount received IN THE PAST 12 MONTHS for each "Yes" response.

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 the "No" box for the other person.

When reporting income received jointly, DO NOT include the amount for a person not listed on pages 2, 3, or 4.

47d. Include amounts, before Medicare deductions, of Social Security and/or Railroad Retirement payments to retired persons, to dependents of deceased insured workers, and to disabled workers.

47. INCOME IN THE PAST 12 MONTHS.

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 to the right of the dollar amount.

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.

47d. Include amounts, before Medicare deductions, of Social Security and/or Railroad Retirement payments to retired persons, to dependents of deceased insured workers, and to disabled workers.

47. INCOME IN THE PAST 12 MONTHS.

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 to the right of the dollar amount.

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.

41d.Include amounts, before Medicare deductions, of Social Security and/or Railroad Retirement payments to retired persons, to dependents of deceased insured workers, and to disabled workers.

31. INCOME IN 1999 - Mark [X] the ?Yes? box for each income source received during 1999 and enter the total amount received during 1999 to a maximum of $999,999. Mark [X] the ?No? box if the income source was not received. If net income was a loss, enter the amount and mark [X] the ?Loss? box next to the dollar amount.

For income received jointly, report, if possible, the appropriate share for each person; otherwise, report the whole amount for only one person and mark the ?No? box for the other person. If exact amount is not known, please give best estimate.

d. Social Security or Railroad Retirement

32. INCOME IN 1989 -

Fill the "Yes" circle below for each income source received during 1989. Otherwise, fill the "No" circle. If "Yes," enter the total amount received during 1989. For income received jointly, see instruction guide. If exact amount is not known, please give best estimate. If net income was a loss, write "Loss" above the dollar amount.

"Fill the Yes or No circle for each part and enter the amount received during 1989. 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 fill the No circle for the other person."

e. Social Security or Railroad Retirement . . .

"Include Social Security or Railroad Retirement payments to retired persons, to dependents of deceased insured workers and to disabled workers."

[All]
41. Income other than earnings in 1969 - Fill in parts a, b, and c. (If exact amount is not known, give best estimate.) "Enter the amount or fill the None circle in a, b, and c."

[All]
41. Income other than earnings in 1969 - Fill in parts a, b, and c. (If exact amount is not known, give best estimate.) "Enter the amount or fill the None circle in a, b, and c."