Commercial Debtor Financial Statement Page 4
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4Section III Income and Expense Analysis
The following information applies to income and expenses during the period
Accounting method used
to
Income
Expenses
28 Gross receipts from sales, services, etc.
34 Materials purchased
$
$
29 Gross rental income
(Number of employees………….)
35 Net wages and salaries
30 Interest,
36 Rent
31 Dividends
(Treasury use only)
37 Allowable installment payments
32 Other income (specify)
38 Supplies
39 Utilities/telephone
40 Gasoline/oil
41 Repairs and maintenance
42 Insurance
43 Current taxes
44 Other (specify)
33 Total income
$
45 Total expenses (Treasury use only)
$
46 Net difference (Treasury use only)
$
Certification: Under penalties of perjury, I declare that to the best of my knowledge and belief this statement of assets, liabilities, and other information is
true, correct, and complete.
47
Signature
48 Date
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