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Complete a separate "Other Income" form for a spouse if applicable.

Check box if this form is related to:Taxpayer or Spouse

Alimony received: or Not Applicable (N/A):

Self Employed Income:  or N/A:

Self Employed Deductions: or N/A:

Rental Income: or N/A:

Rental Deductions:   or N/A:

Income from an Estate or Trust: or N/A:

Deductions from Estate or Trust: or N/A:

Income from a Partnership: or N/A:

Deductions from Partnership: or N/A:

Income from an S-Corporation: or N/A:

Deductions from an S-Corporation: or N/A:

Farming Income:   or N/A:

Farming Deductions:   or N/A:

Distributions from tuition or education savings program:  or N/A:

Jury Duty Pay: or N/A:

Taxable Grants:   or N/A:

Insurance Reimbursements: or N/A:

Comments or questions you want to add with this submitted information on this page:

After completing the information for this page, please review your entries and then click on the submit button below.  Just click on the submit button once and a confirmation page should display your entries and allow you to return to this form to enter information related to your spouse if applicable.