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Text File  |  1987-08-31  |  4KB  |  75 lines
  1.  
  2.                          [YEARLY SOURCES OF INCOME]
  3.  
  4.  
  5.   EARNED INCOME        HUSBAND   WIFE    OTHER    TOTAL    MONTHLY 
  6. |                    |        |        |        |        |         |
  7. | Salary and wages___|________|________|________|________|_________|
  8. |                    |        |        |        |        |         |
  9. | Self-employment____|________|________|________|________|_________|     
  10. |                    |        |        |        |        |         |
  11. | Bonus______________|________|________|________|________|_________|     
  12. |                    |        |        |        |        |         |
  13. | INVESTMENT INCOME__|________|________|________|________|_________|     
  14. |                    |        |        |        |        |         |
  15. | Interest on savings|________|________|________|________|_________|     
  16. |                    |        |        |        |        |         |
  17. | Interest from bonds|________|________|________|________|_________|
  18. |                    |        |        |        |        |         |
  19. | Dividends__________|________|________|________|________|_________|     
  20. |                    |        |        |        |        |         |
  21. | Rental income______|________|________|________|________|_________|     
  22. |                    |        |        |        |        |         |
  23. | Trust income_______|________|________|________|________|_________|     
  24. |                    |        |        |        |        |         |
  25. | PENSIONS/ANNUITIES_|________|________|________|________|_________|     
  26. |                    |        |        |        |        |         |
  27. | Social Security____|________|________|________|________|_________|     
  28. |                    |        |        |        |        |         |
  29. | Employers's pension|________|________|________|________|_________|     
  30. |                    |        |        |        |        |         |
  31. | IRA________________|________|________|________|________|_________|     
  32. |                    |        |        |        |        |         |
  33. | Other______________|________|________|________|________|_________|     
  34. |                    |        |        |        |        |         |
  35. | OTHER INCOME_______|________|________|________|________|_________|     
  36. |                    |        |        |        |        |         |
  37. | Gifts              |        |        |        |        |         |     
  38. | Unemployment,      |        |        |        |        |         |
  39. | disability insur.__|________|________|________|________|_________|     
  40. |                    |        |        |        |        |         |
  41. | Alimony/child sppt.|________|________|________|________|_________|     
  42. |                    |        |        |        |        |         |
  43. | Other______________|________|________|________|________|_________|     
  44. |                    |        |        |        |        |         |
  45. | GROSS INCOME_______|________|________|________|________|_________|     
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  52. ====================================================================
  53.                               DEDUCTIONS
  54. ====================================================================
  55.    EARNED INCOME       HUSBAND   WIFE    OTHER    TOTAL    MONTHLY 
  56. |                    |        |        |        |        |         |
  57. |TAXES_______________|________|________|________|________|_________|     
  58. |                    |        |        |        |        |         |
  59. |Federal_____________|________|________|________|________|_________|     
  60. |                    |        |        |        |        |         |
  61. |State_______________|________|________|________|________|_________|     
  62. |                    |        |        |        |        |         |
  63. |Local_______________|________|________|________|________|_________|     
  64. |                    |        |        |        |        |         |
  65. |SOCIAL SECURITY     |        |        |        |        |         |
  66. |CONTRIBUTION TO     |        |        |        |        |         |
  67. |BENEFITS____________|________|________|________|________|_________|     
  68. |                    |        |        |        |        |         |
  69. |OTHER_______________|________|________|________|________|_________|     
  70. |                    |        |        |        |        |         |
  71. |NET INCOME__________|________|________|________|________|_________|     
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