Example Income Calculation Worksheet Page 8
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8Net Self-Employment Income
Applicant
Spouse
1. Estimated net monthly self-employment or
$__________ x 12 months = ___________
$__________ x 12 months = ___________
partnership income.
2. Repeat for all types of self-employment or
$__________ x 12 months = ___________
$__________ x 12 months = ___________
partnership income you receive.
+ $__________ x 12 months = ___________
+ $__________ x 12 months = ___________
TOTAL Net Self-Employment Income
$__________ x 12 months = ___________
$__________ x 12 months = ___________
Retirement Income
Applicant
Spouse
1. Retirement income you receive times the
$__________ x _________ = ___________
$__________ x _________ = ___________
frequency with which you receive that
frequency
frequency
income.
2. Add amount withheld from your income
+ $__________ x _________ = ___________
+ $__________ x _________ = ___________
such as taxes or insurance premiums.
frequency
frequency
TOTAL Retirement Income
$__________ x _________ = ___________
$__________ x _________ = ___________
frequency
frequency
Other Income
Applicant
Spouse
1. Other income you receive times the
$__________ x _________ = ___________
$__________ x _________ = ___________
frequency with which you receive that
frequency
frequency
income.
2. Add amount withheld from your income
+ $__________ x _________ = ___________
+ $__________ x _________ = ___________
such as taxes or insurance premiums.
frequency
frequency
TOTAL Other Income
$__________ x _________ = ___________
$__________ x _________ = ___________
frequency
frequency
Applicant
Spouse
GRAND TOTAL (Optional)
Add all totals. Round income to the nearest
dollar.
$ ____________
$ _____________
8
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