Literal question
41. Income in the past 12 months.</p>
<div class="i1">Mark (X) the "Yes" box for each type of income this person received, and give your best estimate of the total amount during the past 12 months. (Note: The "past 12 months" is the period from today's date one year ago up through today.)<br />Mark (X) the "No" box to show types of income <span class="em">not</span> received.<br />If net income was a loss, mark the "Loss" box to the right of the dollar amount.<br />For income received jointly, report the appropriate share for each person, or, if that's not possible, report the whole amount for only one person and mark the "No" box for the other person.</div><p>a) Wages, salary, commissions, bonuses, or tips from all jobs.</p>
<div class="i1">Report amount before deductions for taxes, bonds, dues, or other items<br /><br />[] Yes, $____.00 (total amount for past 12 months)<br />[] No</div><p>b) Self-employment income from own non-farm businesses or farm businesses, including proprietorships and partnerships.</p>
<div class="i1">Report net income after business expenses.<br /><br />[] Yes, $____.00 (total amount for past 12 months)<br />[] No<br />[] Loss</div><p>c) Interest, dividends, net rental income, royalty income, or income from estates and trusts.</p>
<div class="i1">Report even small amounts credited to an account<br /><br />[] Yes, $____.00 (total amount for past 12 months)<br />[] No<br />[] Loss</div><p>d) Social Security or Railroad Retirement</p>
<div class="i1">[] Yes, $____.00 (total amount for past 12 months)<br />[] No</div><p>e) Supplemental Security Income (SSI)</p>
<div class="i1">[] Yes, $____.00 (total amount for past 12 months)<br />[] No</div><p>f) Any public assistance or welfare payments from the state or local welfare office.</p>
<div class="i1">[] Yes, $____.00 (total amount for past 12 months)<br />[] No</div><p>g) Retirement, survivor, or disability pensions. Do not include Social Security.</p>
<div class="i1">[] Yes, $____.00 (total amount for past 12 months)<br />[] No</div><p>h) Any such 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</p>
<div class="i1">[] Yes, $____.00 (total amount for past 12 months)<br />[] No</div><p>42. What was this person's total income during the past 12 months?</p>
<div class="i1">Add entries in questions 40a to 40h; subtract any losses. If net income was a loss, enter the amount and mark (X) the "Loss" box next to the dollar amount.<br /><br />[] None <br /><span class="em">or</span><br />$____.00 (total amount for past 12 months)<br />[] Loss</div>
