Questionnaire Text

Questionnaire form view entire document:  text  image
[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."

a. How much did this person receive in 1969 from Social Security or Railroad Retirement?
$ ____________.00
(Dollars only)

OR
[] None
"Social Security or Railroad Retirement - include U.S. Government payments to retired persons, to dependents of deceased insured workers, or to disabled workers. Include "Medicare" premiums; exclude receipts."