Nursing Professional Deductions Form Page 2
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1
2Vehicle Expense
Do you have a company provided car including gas card? (If yes, no applicable deduction)
Yes
No
Are you reimbursed either on a base monthly amount or per mile amount for your travel?
Yes
No
If yes, what is the total amount received during 2008
$
You have an option of taking actual expenses on your vehicle or a per mile deduction – Please complete the following information:
Vehicle expenses for year, gas, repair, tires, etc
$
Is this evidence written?
Yes
or
No
Type & Year of Vehicle:
If you lease, what is the monthly payment?
$
Date First Used for Business:
/
/
Number of Miles Driven for Business
mi.
Do you have another car for personal use?
Yes or
No
Number of Miles Driven for Personal
mi.
Do you have evidence to support the deduction? Yes or No
Number of Miles Driven for Commuting
mi.
Home Office
In order to qualify for a home office deduction, you must be required by your employer to have an office at home or be self employed
Square Footage of Home
sq./ft
Cost of Utilities per Month
$
Square Footage of Space/Room Used
sq./ft
Amount of Rent Paid per Month
$
Purchase Price of Home
$
Insurance – Homeowners/Renters
$
Number of Months Office was in Home
Other - Specify
$
Traveling Nurse
Do you maintain a primary residence (Home, condo, apartment) at a location other than your work assignment?
Yes
No
As long as you maintain a permanent residence in the state you claim as your tax home and return to that residence on a regular basis, you will be
eligible to take advantage of your expenses while away from home on assignment.
st
City Location of 1st the Assignment
Number of Days on 1
Assignment
nd
nd
City Location of 2
the Assignment
Number of Days on 2
Assignment
rd
rd
City Location of 3
the Assignment
Number of Days on 3
Assignment
Were you provided Housing?
Yes
or
No
Were you paid a per diem on Assignment
Yes or No
Were you reimbursed a set amount for housing?
$
Amount of per diem paid
$
Hotel/Housing Expense
$
Utility Expense for Assignment
$
Local Transportation during Assignment
$
Local/LD Phone Usage During Assignment
$
Commuting Expense Home During Assignment
$
Other Expenses due to relocation
$
Contract/Self Employed Nurses
As a self employed professional, your expenses for supporting and maintaining your business are deductible.
Advertising
$
Meals
$
Business Insurance (not health)
$
Utilities – Outside of Home
$
Interest - Mortgage
$
Other Int.
$
Dues & Publications
$
Legal & Professional Fees
$
Postage & Shipping
$
Rent – Outside of Home
$
Telephone
$
Repairs
$
Bank Charges
$
Supplies
$
Self Employed Health Insurance
$
Taxes
$
Other (Specify)
$
Travel
$
Equipment Purchased – Complete information below
Entertainment
$
Date you started your business:
/
/
List Office Equipment Purchased
Date Purchased
Placed in Service
Amount
/
/
/
/
$
/
/
/
/
$
/
/
/
/
$
Comments and Other Expenses:
317-984-7666
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