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Text File  |  1984-06-09  |  2KB  |  20 lines
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  5. ┌─────────────╓╔╩╦╠═********************************************************    
  6. *      First name  Initial  Spouse's name  Last  Name       Social Sec     *    
  7. *    ________________ _ _____________ ___________________▌___ ▌__ ▌ ____   *    
  8. *      Present Address include apt #                                       *    
  9. *    ____________________________________________________▌___ ▌__ ▌ ____   *    
  10. *         City, town, post off  State and Zip ▌                            *    
  11. *    _________________________________________▌                            *    
  12. *                                                                          *    
  13. *       Total income    _________     Total Adjustments  _________         *    
  14. *                                                                          *    
  15. *             ADJusted Gross Income     _________                          *    
  16. *                                                                          ─    
  17. ***************************************************************************┘    
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