If
any of the following items pertain to you or your spouse
for the year of 1998, please check the appropriate box
and include all pertinent details.
YES
NO
Were there any
births, adoptions, marriages, divorces, or deaths
in your immediate family during the
year?
Are any of your
unmarried children, who might be claimed as
dependents, 19 years of age or
older?
Do you have any
children under age 14 with Interest and dividend
income in excess of $500, or total investment
income in excess of $1300?
Are any of your
unmarried children, who might be claimed as
dependents, 19 years of age or
older?
Can you be
claimed as a dependent on another person's tax
return?
Did you or your
spouse "rollover" a profit-share or retirement
plan distribution into another plan? If yes, enter
the amount $____________________, and attach Form
1099-R.
Did you or your
spouse receive any disability income during the
year? If yes, enter the amount
$____________________.
Did you
purchase, sell, or refinance your principal home
or your second home, or make a home equity loan
during the year? If yes, please provide escrow
papers and other relevant
information.
Did you sell any
stocks, bonds, or other investment property during
the year? If yes, please list the description,
date acquired, date sold, sales price, cost or
basis, and expenses of sale.
Did you pay any
one household employee cash wages of $1,000 or
more in 1995; withhold federal income tax during
1995 at the request of any household employee; or
pay total cash wages of $1,000 or more in any
calendar quarter of 1994 or 1995 to house
employees?
Did you use your
car on the job(other than to and from
work)?
Does anyone owe
you money which has become
uncollectible?
Did you incur
moving expenses during the year due to a change of
employment?
Did you or your
spouse work out of town for part of the
year?
Did you incur a
loss because of damaged or stolen
property?
Did you cash in
any series EE U.S. savings bonds issued after
1989?
Did you have any
Series E Bonds issued in 1955 or
1965?
Do you or your
spouse want to allocate $3 ot the Presidential
Election Campaign Fund?
Did you have an
interest in or signature over a bank or brokerage
account i a foreign country, or were you a grantor
of or transferrer to a foreign
trust?
Were you audited
by either the Internal Revenue Service or the
State taxing agency during the
year?
Did your receive
any K-1s from partnerships estates, trust, LLCs?
If so, please
attach.