Please answer each required question

Self - Name
Self - Date of Birth
Spouse - Name
Spouse - Date of Birth
Dependent #1 - Name
Dependent #1 - Date of Birth
Dependent #2 - Name
Dependent #2 - Date of Birth
Dependent #3 - Name
Dependent #3 - Date of Birth
Self Income
Spouse Income
Other Income
Total Income
Spouse
Other
Total
Miscellaneous Income Self
Miscellaneous Income (Spouse)
Miscellaneous Income (Other)
Miscellaneous Income (Total)
Add All 4 Fields