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HOUSING QUESTIONS <br />c. Interest, dividends, net rental income, royalty <br />income, or income from estates and trusts -Report <br />even small amounts credited to an account. <br />Yes Annual amount -Dollars <br />;,,- <br />-'~ O Loss <br />O No <br />d. Social Security or Railroad Retirement <br />O Yes Annual amount -Dollars <br />O No <br />.'C <br />e. Supplemental Security Income (551) <br />O Yes Annual amount -Dollars <br />O No <br />i'C <br />f. Any public assistance or welfare payments <br />from the state or local welfare office <br />O Yes Annual amount -Dollars <br />/' :~~ <br />O No <' ` <br />~~ <br />g. Retirement, survivor, or disability pensions, ~~ ~, <br />~o NOT include Social Security. ~~~~ ~~ <br />J Yes Annual amount -Dollars ~ .`\\ ~ <br />,~, \, `~. <br />:~,\ , <br />h. Any other sources of inco~ne_,tacarved regularly <br />such as Veterans' (VA) pay~e,~ts unemployment <br />compensation, child support^a~ alimony - Do NOT <br />include lump-sum payments suc~i as money from an <br />inheritance or sale of a home. <br />O Yes Annual amount - Dollars <br />O No <br />.v~i' <br />What was this person's total income in 1999? Add <br />entries in questions 31 a-31 h; subtract any losses. /f net <br />income was a loss, enter the amount and mark Q the <br />"Loss" box next to the dollar amount. <br />Annual amount -Dollars <br />O None OR ? •~~ O Loss <br />( ~' Question is asked of all households on <br />- the short (100-percent) and long <br />!~ (sample) forms. <br />Now, please answer questions 33-53 about <br />your household. <br />Is this house, apartment, or mobile home - <br />O Owned by you or someone in this household with a <br />mortgage or loan? <br />O Owned by you or someone in this household free and <br />clear (without a mortgage or loan)? <br />O Rented for cash rent? <br />O Occupied without payment of cash rent? <br />Which best describes this building? Include all <br />apartments, flats, etc., even if vacant. <br />O A mobile home <br />O Aone-family hol~se~c etched from any other house <br />O A one-familyhQ~ ~~attached to one or more houses <br />O A building ~i~\ith~':~ apartments <br />O A build'i~g vv~f#F3 or 4 apartments <br />O A buildir'g~vith 5 to 9 apartments <br />O A` building with 10 to 19 apartments <br />'\ <br />O(r~~u?"dmg with 20 to 49 apartments <br />• "building with 50 or more apartments <br />~.,.~ v <br />~~ ~a0at, RV, van, etc. <br />About when was this building first built? <br />O 1999 or 2000 <br />O 1995 to 1998 <br />O 1990 to 1994 <br />O 1980 to 1989 <br />O 1970 to 1979 <br />O 1960 to 1969 <br />O 1950 to 1959 <br />O 1940 to 1949 <br />O 1939 or earlier <br />When did this person move into this house, <br />apartment, or mobile home? <br />O 1999 or 2000 <br />O 1995 to 1998 <br />O 1990 to 1994 <br />O 1980 to 1989 <br />O 1970 to 1979 <br />O 1969 or earlier <br />How many rooms do you have in this house, <br />apartment, or mobile home? Do NOT count bathrooms, <br />porches, balconies, foyers, halls, or half-rooms. <br />O 1 room O 6 rooms <br />O z rooms ~ O 7 rooms <br />O 3 rooms O 8 rooms <br />O 4 rooms O 9 or more rooms <br />O 5 rooms <br />Form p.618 <br />