1a. List on the numbered lines below the name of each person living here on Sunday, April 1, including all persons staying here who have no other home. If EVERYONE at this address is staying here temporarily and usually lives somewhere else, follow the instructions given in question 1b below.
Include
Everyone who usually lives here such as family members, housemates and roommates, foster children, roomers, boarders, and live-in employees
Persons who are temporarily away on a business trip, on vacation, or in a general hospital
College students who stay here while attending college
Persons in the Armed Forces who live here
Newborn babies still in the hospital
Children in boarding schools below the college level
Persons who stay here most of the week while working even if they have a home somewhere else
Persons with no other home who are staying here on April 1
Do NOT includePersons who usually live somewhere else
Persons who are away in an institution such as a prison, mental hospital, or a nursing home
College students who live somewhere else while attending college
Persons in the Armed Forces who live somewhere else
Persons who stay somewhere else most of the week while working
Print last name, first name, and middle initial for each person. Begin on line 1 with the household member (or one of the household members) in whose name this house or apartment is owned, being bought, or rented [the head of household]. If there is no such person, start on line 1 with any adult household member.
LAST FIRST INITIAL
1. _____________________________________________.
2. _____________________________________________.
3. _____________________________________________.
4. _____________________________________________.
5. _____________________________________________.
6. _____________________________________________.
7. _____________________________________________.
8. _____________________________________________.
9. _____________________________________________.
10. _____________________________________________.
11. _____________________________________________.
12. _____________________________________________.
"List everyone who lives at this address in question 1a. If you are not sure if you should list a person, see the rules on page 1 of the census form. If you are still not sure, answer as best you can and fill in "Yes" for question H1a or H1b, as appropriate. If there are more than seven people in your household, please list all the persons in question 1a, complete the form for seven people, and mail it back in the enclosed envelope. A census taker will call to obtain the information for the additional persons."
2. How is this person related to PERSON 1 [the head of household]?
Fill ONE circle for each person. If Other relative of person in column 1, fill circle and print exact relationship, such as mother-in-law, grandparent, son-in-law, niece, cousin, and so on.
[Person 1 was not to answer this question.]
If a RELATIVE of Person 1:
[] Husband/wife
[] Natural-born or adopted son/daughter
[] Stepson/stepdaughter
[] Brother/sister
[] Father/mother
[] Grandchild
[] Other relative:
____________________
If NOT RELATED to Person 1:
[] Roomer, boarder, or foster child
[] Housemate, roommate
[] Unmarried partner
[] Other nonrelative
"Fill one circle to show how each person is related to the person in column 1. If Other relative of the person in column 1, print the exact relationship such as son-in-law, daughter-in-law, grandparent, nephew, niece, mother-in-law, father-in-law, cousin, and so on. If the Stepson/stepdaughter of the person in column 1 also has been legally adopted by the person in column 1, mark Stepson/stepdaughter but do not mark Natural-born or adopted son/daughter. In other words, Stepson/stepdaughter takes precedence over Adopted son/daughter."
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."
a. Wages, salary, commissions, bonuses, or tips from all jobs - Report amount before deductions for taxes, bonds, dues, or other items.
[] Yes
[] No $________________ .00
Annual amount - Dollars
"Include wages and salaries from all jobs before deductions. Be sure to include any tips, commissions, or bonuses. Owners of incorporated businesses should enter their salary here. Military personnel should include base pay plus cash housing and/or subsistence allowance, flight pay, uniform allotments, reenlistment bonuses, etc."
b. Self-employment income from own nonfarm business, including proprietorship and partnership -
Report NET income after business expenses.
[] Yes
[] No $________________ .00
Annual amount - Dollars
"Include NONFARM profit (or loss) from self-employment in sole proprietorships and partnerships. Exclude profit (or loss) of incorporated businesses you own."
c. Farm self-employment income - Report NET income after operating expenses. Include earnings as a tenant farmer or sharecropper.
[] Yes
[] No $________________ .00
Annual amount - Dollars
"Include FARM profit (or loss) from self-employment in sole proprietorships and partnerships. Exclude profit (or loss) of incorporated farm businesses you own. Also exclude amounts from land rented for cash but include amounts from land rented for shares."
d. Interest, dividends, net rental income or royalty income, or income from estates and trusts -
Report even small amounts credited to an account.
[] Yes
[] No $________________ .00
Annual amount - Dollars
"Include interest received or credited to checking and savings accounts, money market funds, certificates of deposit (CDS), IRAs, KEOGHs, and government bonds. Include dividends received, credited, or reinvested from ownership of stocks or mutual funds. Include profit (or loss) from royalties and the rental of land, buildings or real estate, or from roomers or boarders. Income received by self-employed persons whose primary source of income is from renting property or from royalties should be included in questions 32b or 32c above. Include regular payments from an estate or trust fund."
e. Social Security or Railroad Retirement [] Yes
[] No $________________ .00
Annual amount - Dollars
"Include Social Security (and/or Railroad Retirement) payments to retired persons, to dependents of deceased insured workers, and to disabled workers before Medicare deductions."
f. Supplemental Security Income (SSI), Aid to Families with Dependent Children (AFDC), or other public assistance or public welfare payments. [] Yes
[] No $________________ .00
Annual amount - Dollars
"Include Supplemental Security Income received by aged, blind, or disabled persons, Aid to Families with Dependent Children, or income from other government programs such as general or emergency assistance. Do not include assistance received from private charities. Exclude assistance to pay for heating (cooling) costs."
g. Retirement, survivor, or disability pensions - Do NOT include Social Security.
[] Yes
[] No $________________ .00
Annual amount - Dollars
"Include retirement, disability, or survivor benefits received from companies and unions; Federal, State, and local governments, and the U.S. military. Include regular income from annuities and IRA or KEOGH retirement plans."
h. Any other sources of income received regularly such as Veterans' (VA) payments, unemployment compensation, child support, or alimony - Do NOT include lump-sum payments such as money from an inheritance or the sale of a home.
[] Yes
[] No $________________ .00
Annual amount - Dollars
"Include Veterans' (VA) disability compensation and educational assistance payments (VEAP), unemployment compensation, child support or alimony, and all other regular payments such as Armed Forces transfer payments; assistance from private charities; regular contributions from persons not living in the household, etc.
"Do not include the following as income in any item:
- Refunds or rebates of any kind
- Withdrawals from savings of any kind
- Capital gains or losses from the sale of homes, shares of stock, etc.
- Inheritances or insurance settlements
- Any type of loan
- Pay in-kind such as food, free rent, etc."