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<br />Industry or Employer -Describe clearly this person's
<br />chief job activity or business last week. If this person had
<br />more than one job, describe the one at which this person
<br />worked the most hours. If this person had no job or
<br />business last week, give the information for his/her last job
<br />or business since 1995.
<br />a. For whom did this person work? !f now on
<br />active duty in the Armed Forces, mark Q this box --~ ^
<br />and print the branch of the Armed Forces.
<br />Name of company, business, or other employer
<br />b. What kind of business or industry was this?
<br />Describe the activity at location where employed. (for
<br />example: hospital, newspaper publishing, mail order
<br />house, auto repair shop, bank)
<br />:~,.
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<br />c. Is this mainly - Mark Q ONE box. ,,~`'~ ~~
<br />~ ~` ;~~•'
<br />^ Manufacturing? ~,,, ,.;
<br />^ Wholesale trade? '~ '~~ '~-~}
<br />^ Retail trade? ~,%~ ~;; r`
<br />^ Other (agriculture, constrc:ct~irir:; service,
<br />government, etc.)? ., ~ ~,~ ~~
<br />%,
<br />Occupation
<br />a. What kind of woilt-viras,this person doing?
<br />(for example: registernurse, personnel manager,
<br />supervisor of order department, auto mechanic, accountant)
<br />b. What were this person's most important
<br />actiivities or duties? (For example: patient care,
<br />directing hiring policies, supervising order Jerks, repairing
<br />automobiles, reconciling financial records)
<br />m, umiiiuiui
<br />Was this person - Mark Q ONE box.
<br />^ Employee of a PRIVATE-FOR-PROFIT company or
<br />business or of an individual, for wages, salary, or
<br />commissions
<br />^ Employee of a PRIVATE NOT-FOR-PROFIT,
<br />tax-exempt, or charitable organization
<br />^ Local GOVERNMENT employee (city, county, etc)
<br />^ State GOVERNMENT employee
<br />^ Federal GOVERNMENT employee
<br />^ SELF-EMPLOYED in own NOT INCORPORATED
<br />business, professional practice, or farm
<br />^ SELF-EMPLOYED in own INCORPORATED business,
<br />professional practice, or farm
<br />^ Working WITHOUT PAY in family business or farm
<br />a. LAST YEAit;.1999, did this person work at a
<br />job or business at any time?
<br />^ No ~ `Skip ro 31
<br />:. b. How many weeks did this person work in 1999?
<br />~'~ C'ount paid vacation, paid sick leave, and military service.
<br />`-~ ~ ~~'Jeeks
<br />c. During the weeks WORKED in 1999, how many
<br />hours did this person usually work each WEEK?
<br />Usual hours worked each WEEK
<br />INCOME IN 1999 - Mark Q the "Yes" box for each
<br />income source received during 1999 and enter the total
<br />amount received during 1999 to a maximum of $999,999.
<br />Mark Q the 'No' box if the income source was not
<br />received. If net income was a loss, enter the amount and
<br />mark Q the "Loss' box next to the dollar amount.
<br />for income received jointly, report if possible, the
<br />appropriate share for each person; otherwise, report
<br />the whole amount for only one person and mark Q
<br />the "No" box for the other person. If exact amount is
<br />not known, please give best estimate.
<br />a. Wages, salary, commissions, bonuses, or tips
<br />from all jobs -Report amount before deductions for
<br />taxes, bonds, dues, or other items.
<br />^ Yes Annual amount -Dollars
<br />^ No
<br />a ~:~t}
<br />b. Self-employment income from own nonfarm
<br />businesses or farm businesses, inducting
<br />proprietorships and partnerships -Report NET
<br />income after business expenses.
<br />^ Yes Annual amount - DoNars
<br />' `''~ ^ Loss
<br />^ No
<br />Form D-61B
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