Questionnaire Text

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[All]
40. Earnings in 1969 - Fill parts a, b, and c for everyone who worked any time in 1969 even if he had no income. (If exact amount is not known, give best estimate.)

a. How much did this person earn in 1969 in wages, salary, commissions, bonuses, or tips from all jobs? (Before deductions for taxes, bonds, dues, or other items.)
$ ____________.00
(Dollars only)

OR
[] None
b. How much did he earn in 1969 from his own nonfarm business, professional practice, or partnership? (Net after business expenses. If business lost money, write "Loss" above amount.)
$ ____________.00
(Dollars only)

OR
[] None
c. How much did he earn in 1969 from his own farm? (Net after operating expenses. Include earnings as a tenant farmer or sharecropper. If farm lost money, write "Loss" above amount.)
$ ____________.00
(Dollars only)

OR
[] None
"Enter the amount or fill the None circle in a, b, and c. Part 40a includes "sick leave" pay. Part 40a excludes military bonuses, reimbursement for business expenses, and pay "in kind." The owner of an unincorporated nonfarm business should include his net earnings in part 40b. If the business or farm is incorporated, his earnings should be included in part 40a."
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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."
b. How much did he receive in 1969 from public assistance or welfare payments?
Include aid for dependent children, old age assistance, general assistance, aid to the blind or totally disabled. Exclude separate payments for hospital or other medical care.
$ ____________.00
(Dollars only)

OR
[] None
"Public assistance or public welfare payments - include amounts received from Federal, State, or local public programs. Exclude private welfare payments."
c. How much did he receive in 1969 from all other sources?
Include interest, dividends, veterans' payments, pensions, and other regular payments.
(See instruction sheet.)
$ ____________.00
(Dollars only)

OR
[] None
"Interest, dividends - include amounts received or credited to your account.

Veterans' payments - include money paid for service-connected disabilities, to survivors of deceased veterans, for education and on-the-job training subsistence allowances, and for 'refunds' on 'GI' insurance premiums.

Retirement pensions - include amounts paid by former private employers and by unions, and amounts paid by Federal, State, county, or other governmental agencies.

Other regular payments - include such periodic income as net rental income, unemployment insurance benefits, workmen's compensation, private welfare payments, alimony or child support, Armed Forces allotments, and regular contributions from persons who are not members of your household.

Exclude receipts from the sale or personal property, capital gains, lump-sum insurance or inheritance payments, or pay 'in kind.'"