Chapter 13 Monthly Business Operating Statement Form
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2CHAPTER 13 MONTHLY BUSINESS OPERATING STATEMENT
Case Number: _______________
Debtor(s) Name(s): __________________________
Financial Report for: _____________________________ (month and year)
1. INCOME.
Gross Business Receipts / Sales
$____________
Sales Taxes Collected
$____________
TOTAL INCOME. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $___________
0
2. COSTS AND EXPENSES.
Advertising & Promotion
$___________
Auto Fuel & Operations
$___________
Debt Payments by Corp. or LLC (do not incl. any debts
included in the case or the plan payment):
(a) ________________________
$___________
(b) ________________________
$___________
(c) ________________________
$___________
Employee Benefits:
(a) Hospitalization & Medical
$___________
(b) Retirement
$___________
(c) Other
$___________
Insurance Premiums (fire, theft, liability, etc.)
$___________
Inventory, Materials & Supplies
$___________
Legal & Accounting
$___________
Maintenance & Repairs
$___________
Office Supplies
$___________
Other Business Expenses (itemize):
(a) ________________________
$___________
(b) ________________________
$___________
Postage & Shipping
$___________
Rent or Lease Expense for Business Location
$___________
Salaries, Wages, Bonuses (gross amt., do not incl. owner’s comp.)
$___________
Taxes:
Employer’s FICA (social security) contributions
$___________
Sales Taxes
$___________
Unemployment Taxes
$___________
Telephone & Utilities
$___________
Workers’ Compensation Insurance
$___________
TOTAL COSTS AND EXPENSES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $____________
0
0
3. NET INCOME (LOSS). (Total Income [#1] less Total Costs & Expenses [#2]. . . . . . . . . . . . . . . . . . $____________
4. Total funds on hand and in bank account(s)
$_____________
5. Total value of inventory on hand (cost basis)
$_____________
6. Total accounts receivable
$_____________
7. Total accounts payable
$_____________
I/We declare under penalty of perjury that the information provided is true and correct.
Dated: ____________________, 20____.
___________________________________
___________________________________
Debtor
Debtor
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