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Survey form
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Ask 15d-f as appropriate for each person with "Dividends" marked in 15b.

d. What is your best estimate of the total amount that -- received from dividends, NET rental property income, royalties, estates, or trusts in (month)?

d. What is your best estimate of the total amount that -- received from dividends, NET rental property income, royalties, estates, or trusts in (month)?

1[] Already included (15d for NP with 15b, or 16)

0[] Loss (15d for NP with 15b, or 16)

$______ (15d for NP with 15b, or 16)

(Dollars)

9999[] DK (15e)

0[] Loss (15d for NP with 15b, or 16)

$______ (15d for NP with 15b, or 16)

(Dollars)

9999[] DK (15e)

e. Was it more than $25 or less than $25?

1[] More that $25 (15f)

2[] Less than $25 (15d for NP with 15b, or 16)

3[] $25 exactly (15d for NP with 15b, or 16)

9[] DK (15d for NP with 15b, or 16)

2[] Less than $25 (15d for NP with 15b, or 16)

3[] $25 exactly (15d for NP with 15b, or 16)

9[] DK (15d for NP with 15b, or 16)

Hand card FD2.

CARD FD2

1[] $25 - $99

2[] $100 - $499

3[] $500 - $999

4[] $1000 - $4999,

5[] $5000 or more

2[] $100 - $499

3[] $500 - $999

4[] $1000 - $4999,

5[] $5000 or more

f. Was it -- Read answer categories.

1[] $25 - $99 (15d for NP with 15b, or 16)

2[] $100 - $499 (15d for NP with 15b, or 16)

3[] $500 - $999 (15d for NP with 15b, or 16)

4[] $1000 - $4999, or (15d for NP with 15b, or 16)

5[] $5000 or more? (15d for NP with 15b, or 16)

9[] DK (15d for NP with 15b, or 16)

2[] $100 - $499 (15d for NP with 15b, or 16)

3[] $500 - $999 (15d for NP with 15b, or 16)

4[] $1000 - $4999, or (15d for NP with 15b, or 16)

5[] $5000 or more? (15d for NP with 15b, or 16)

9[] DK (15d for NP with 15b, or 16)

Survey form
view entire document:
text
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Ask 15d-f as appropriate for each person with "Dividends" marked in 15b.

d. What is your best estimate of the total amount that -- received from dividends, NET rental property income, royalties, estates, or trusts in (month)?

d. What is your best estimate of the total amount that -- received from dividends, NET rental property income, royalties, estates, or trusts in (month)?

1[] Already included (15d for NP with 15b, or 16)

0[] Loss (15d for NP with 15b, or 16)

$______ (15d for NP with 15b, or 16)

(Dollars)

9999[] DK (15e)

0[] Loss (15d for NP with 15b, or 16)

$______ (15d for NP with 15b, or 16)

(Dollars)

9999[] DK (15e)

e. Was it more than $25 or less than $25?

1[] More that $25 (15f)

2[] Less than $25 (15d for NP with 15b, or 16)

3[] $25 exactly (15d for NP with 15b, or 16)

9[] DK (15d for NP with 15b, or 16)

2[] Less than $25 (15d for NP with 15b, or 16)

3[] $25 exactly (15d for NP with 15b, or 16)

9[] DK (15d for NP with 15b, or 16)

Hand card FD2.

CARD FD2

1[] $25 - $99

2[] $100 - $499

3[] $500 - $999

4[] $1000 - $4999,

5[] $5000 or more

2[] $100 - $499

3[] $500 - $999

4[] $1000 - $4999,

5[] $5000 or more

f. Was it -- Read answer categories.

1[] $25 - $99 (15d for NP with 15b, or 16)

2[] $100 - $499 (15d for NP with 15b, or 16)

3[] $500 - $999 (15d for NP with 15b, or 16)

4[] $1000 - $4999, or (15d for NP with 15b, or 16)

5[] $5000 or more? (15d for NP with 15b, or 16)

9[] DK (15d for NP with 15b, or 16)

2[] $100 - $499 (15d for NP with 15b, or 16)

3[] $500 - $999 (15d for NP with 15b, or 16)

4[] $1000 - $4999, or (15d for NP with 15b, or 16)

5[] $5000 or more? (15d for NP with 15b, or 16)

9[] DK (15d for NP with 15b, or 16)

Survey form
view entire document:
text
image

Ask 15d-f as appropriate for each person with "Dividends" box marked in 15b.

d. What is your best estimate of the total amount that -- received from dividends, NET rental property income, royalties, estates, or trusts in (month)?

[] 1 Already included (NP with "Dividends" in 15b, or 16)

[] 0 Loss (NP with "Dividends" in 15b, or 16)

(Dollars) $____ (NP with "Dividends" in 15b, or 16)

[] 9999 DK (15e)

[] 0 Loss (NP with "Dividends" in 15b, or 16)

(Dollars) $____ (NP with "Dividends" in 15b, or 16)

[] 9999 DK (15e)

e. Was it more than $25 or less than $25?

[] 1 More that $25 (15f)

[] 2 Less than $25 (NP with "Dividends" in 15b, or 16)

[] 3 $25 exactly (NP with "Dividends" in 15b, or 16)

[] 9 DK (NP with "Dividends" in 15b, or 16)

[] 2 Less than $25 (NP with "Dividends" in 15b, or 16)

[] 3 $25 exactly (NP with "Dividends" in 15b, or 16)

[] 9 DK (NP with "Dividends" in 15b, or 16)

HAND CARD FD2.

CARD FD2

1. $25-$99

2. $100-$499

3. $500-$999

4. $1,000-$4,999

5. $5,000 or more

2. $100-$499

3. $500-$999

4. $1,000-$4,999

5. $5,000 or more

f. Was it --

Read answer categories.

[] 1 $25 - $99 (NP with "Dividends" in 15b, or 16)

[] 2 $100 - $499 (NP with "Dividends" in 15b, or 16)

[] 3 $500 - $999 (NP with "Dividends" in 15b, or 16)

[] 4 $1000 - $4999, or (NP with "Dividends" in 15b, or 16)

[] 5 $5000 or more? (NP with "Dividends" in 15b, or 16)

[] 9 DK (NP with "Dividends" in 15b, or 16)

[] 2 $100 - $499 (NP with "Dividends" in 15b, or 16)

[] 3 $500 - $999 (NP with "Dividends" in 15b, or 16)

[] 4 $1000 - $4999, or (NP with "Dividends" in 15b, or 16)

[] 5 $5000 or more? (NP with "Dividends" in 15b, or 16)

[] 9 DK (NP with "Dividends" in 15b, or 16)