Yes |
No |
Unsure |
Part III – Income – Last Year, Did You (or Your Spouse) Receive |
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1. (B) Wages or Salary? (Form W-2)
If yes, how many jobs did you have last year?
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2. (A) Tip Income? |
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3. (B)Scholarships? (Forms W-2, 1098-T)
Forms W-2 (A)
1098-T (B)
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4. Interest/Dividends from: checking/savings accounts, bonds, CDs, brokerage? (Forms 1099-INT, 1099-DIV)
Forms 1099-INT (A)
1099-DIV (B)
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5. (B) Refund of state/local income taxes? (Form 1099-G) |
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6. (B) Alimony income or separate maintenance payments? |
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7. Self-Employment income? (Form 1099-MISC, 1099-NEC, cash, virtual currency, or other property or services)
Form 1099-MISC (A)
1099-NEC (B)
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8. (A)Cash/check/virtual currency payments, or other property or services for any work performed not reported on Forms W-2 or 1099?
Cash (A)
Check (B)
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9. (A)Income (or loss) from the sale or exchange of Stocks, Bonds, Virtual Currency or Real Estate? (including your home) (Forms 1099-S,1099-B)
Forms 1099-S (A)
1099-B (B)
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10. (A)Disability income? (such as payments from insurance, or workers compensation) (Forms 1099-R, W-2)
Forms 1099-R (A)
W-2 (B)
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11. (A) Retirement income or payments from Pensions. Annuities, and or IRA? (Form 1099-R) |
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12. (B) Unemployment Compensation? (Form 1099G) |
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10. (A)Social Security or Railroad Retirement Benefits? (Forms SSA-1099, RRB-1099)
Forms SSA-1099 (A)
RRB-1099 (B)
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14. (M) Income (or loss) from Rental Property? |
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15. (B) Other income? (gambling, lottery, prizes, awards, jury duty, virtual currency, Sch K-1, royalties, foreign income, other property or services, etc.) Specify
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