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Annual Earnings

Annual
Income Sources Amount Period/Description Earnings

Salary 1 (Gross #)

Salary 2

Wage 1

Wage 2

Aggregated Bonuses

Freelance
Aggregated Interest
Earnings
Health and Dental
Insurance Coverage
Diability and Life
Insurance Coverage
Aggregated Stipends
(tuition, transportation,
conferences)

Retirement Earnings
Trust Fund
Aggregated Stock
Earnings

TOTAL

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