Form Ador 10847 - Collection Information Statement For Businesses Page 6
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10Arizona Department of Revenue
Collection Information Statement for Businesses
Business Name
16
The following information applies to income and expenses for the following period. A minimum of 6 months fi nancial history is
Section 8
required.
Monthly
MM DD YYYY
MM DD YYYY
From
to
.
Income and
Expenses
17
Accounting Method Used:
Cash
Accrual
Complete all
entry spaces
The information included on lines 18 through 38 should reconcile to your Arizona business tax return.
with the most
current data
Total Income
Total Expenses
available not
Source
Gross Monthly
Expense Items
Actual Monthly
to exceed 60
days in age.
18 Gross Receipts
$
26 Materials Purchased
1
$
19 Gross Rental Income
27 Inventory Purchased
2
20 Interest
28 Gross Wages & Salaries
21 Dividends
29 Rent
Other Income (lines 22-24):
3
22
30 Supplies
4
23
31 Utilities/Telephone
24
32 Vehicle Gasoline/Oil
33 Repairs & Maintenance
25 TOTAL INCOME
$
(Add lines 18 through 24)
34 Insurance
35 Current Taxes
5
Other Expenses
(include installment payments, specify in lines 36 - 37):
36
37
(Add lines 26 through 37)
38 TOTAL EXPENSES
$
1
Materials Purchased: Materials are items directly related to the production of a product or service.
2
Inventory Purchased: Goods bought for resale.
3
Supplies: Supplies are items used in your business that are consumed or used up within one year such as the cost of books,
offi ce supplies, professional instruments, etc.
4
Utilities: Utilities include gas, electricity, water, fuel, oil, other fuels, trash collection and telephone.
5
Current Taxes: Real estate, state and local income tax, excise, franchise, occupational, personal property, sales and the
employer’s portion of employment taxes.
Check this
box when all
spaces in
Section 8 are
fi lled in
Section 9 begins on page 7
ADOR 10847 (4/10)
Page 6 of 8
Previous ADOR 20-1020
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Parent category: Financial