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Text File  |  1987-08-31  |  4KB  |  66 lines
  1.                          [YEARLY SOURCES OF INCOME]
  2.  
  3.  
  4.   EARNED INCOME        HUSBAND   WIFE    OTHER    TOTAL    MONTHLY 
  5. |                    |        |        |        |        |         |
  6. | Salary and wages___|________|________|________|________|_________|
  7. |                    |        |        |        |        |         |
  8. | Self-employment____|________|________|________|________|_________|     
  9. |                    |        |        |        |        |         |
  10. | Bonus______________|________|________|________|________|_________|     
  11. |                    |        |        |        |        |         |
  12. | INVESTMENT INCOME__|________|________|________|________|_________|     
  13. |                    |        |        |        |        |         |
  14. | Interest on savings|________|________|________|________|_________|     
  15. |                    |        |        |        |        |         |
  16. | Interest from bonds|________|________|________|________|_________|
  17. |                    |        |        |        |        |         |
  18. | Dividends__________|________|________|________|________|_________|     
  19. |                    |        |        |        |        |         |
  20. | Rental income______|________|________|________|________|_________|     
  21. |                    |        |        |        |        |         |
  22. | Trust income_______|________|________|________|________|_________|     
  23. |                    |        |        |        |        |         |
  24. | PENSIONS/ANNUITIES_|________|________|________|________|_________|     
  25. |                    |        |        |        |        |         |
  26. | Social Security____|________|________|________|________|_________|     
  27. |                    |        |        |        |        |         |
  28. | Employers's pension|________|________|________|________|_________|     
  29. |                    |        |        |        |        |         |
  30. | IRA________________|________|________|________|________|_________|     
  31. |                    |        |        |        |        |         |
  32. | Other______________|________|________|________|________|_________|     
  33. |                    |        |        |        |        |         |
  34. | OTHER INCOME_______|________|________|________|________|_________|     
  35. |                    |        |        |        |        |         |
  36. | Gifts              |        |        |        |        |         |     
  37. | Unemployment,      |        |        |        |        |         |
  38. | disability insur.__|________|________|________|________|_________|     
  39. |                    |        |        |        |        |         |
  40. | Alimony/child sppt.|________|________|________|________|_________|     
  41. |                    |        |        |        |        |         |
  42. | Other______________|________|________|________|________|_________|     
  43. |                    |        |        |        |        |         |
  44. | GROSS INCOME_______|________|________|________|________|_________|     
  45. .paè====================================================================
  46.                               DEDUCTIONS
  47. ====================================================================
  48.    EARNED INCOME       HUSBAND   WIFE    OTHER    TOTAL    MONTHLY 
  49. |                    |        |        |        |        |         |
  50. |TAXES_______________|________|________|________|________|_________|     
  51. |                    |        |        |        |        |         |
  52. |Federal_____________|________|________|________|________|_________|     
  53. |                    |        |        |        |        |         |
  54. |State_______________|________|________|________|________|_________|     
  55. |                    |        |        |        |        |         |
  56. |Local_______________|________|________|________|________|_________|     
  57. |                    |        |        |        |        |         |
  58. |SOCIAL SECURITY     |        |        |        |        |         |
  59. |CONTRIBUTION TO     |        |        |        |        |         |
  60. |BENEFITS____________|________|________|________|________|_________|     
  61. |                    |        |        |        |        |         |
  62. |OTHER_______________|________|________|________|________|_________|     
  63. |                    |        |        |        |        |         |
  64. |NET INCOME__________|________|________|________|________|_________|     
  65.  
  66.