Questionnaire Text

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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.

c. Interest, dividends, net rental income, royalty income, or income from estates and trusts - Report even small amounts credited to an account.

[] Yes
Annual amount - Dollars
$[ ][ ][ ],[ ][ ][ ].00
[] No