List in Question 1
Last name
________________________________
First name Middle initial
________________________________
"List in question 1 ... the names of all the people who usually live here. Then turn to pages 2 and 3 where there are columns to list up to seven persons. In the first column print the name of one of the household members in whose name this home is owned or rented. If no household member owns or rents the living quarters, list in the first column any adult household member who is not a roomer, boarder, or paid employee. Print the names of the other household members, if any, in the columns which follow, using question 1 as a checklist."
2. How is this person related to the person in column 1 [i.e., to the householder]?
Fill one circle. If "Other relative" of person in column 1, give exact relationship, such as mother-in-law, niece, grandson, etc.
If relative of person in column 1:
If not related to person in column 1:
"Fill a circle to show how each person is related to the person in column 1. A stepchild or legally adopted child of the person in column 1 should be marked Son/daughter. Foster children or wards living in the household should be marked Roomer, boarder."
32. Income in 1979 -
Fill circles and print dollar amounts.
If net income was a loss, write "Loss" above the dollar amount.
If exact amount is not known, give best estimate.
For income received jointly by household members, see instruction guide.
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."
a. Wages, salary, commissions, bonuses, or tips from all jobs . . .
"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)."
b. Own nonfarm business, partnership, or professional practice . . .
"Include net earnings (gross receipts minus operating expenses) from a nonfarm business. If business lost money, write "Loss" above the amount."
c. Own farm . . .
"Include net earnings (gross receipts minus operating expenses) from a farm. If farm lost money, write "Loss" above the amount."
d. Interest, dividends, royalties, or net rental income . . .
"Include interest and dividends credited to the person's account (for example, from savings accounts and stock shares), net royalties, and net income from rental property."
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."
f. Supplemental Security (SSI), Aid to Families with Dependent Children (AFDC), or other public assistance or public welfare payments . . .
"Include public assistance or welfare payments received from Federal, State, or local agencies. Do not include private welfare payments."
g. Unemployment compensation, veterans' payments, pensions, alimony or child support, or any other sources of income received regularly . ?
"Include all other regular payments, such as government employee retirement, union or private pensions and annuities; unemployment benefits; worker's compensation; Armed Forces allotments; private welfare payments; regular contributions from persons not living in the household; etc. Do not include lump-sum payments received from the sale of property (capital gains), insurance policies, inheritances, etc."
33. What was this person's total income in 1979?