Financial Statement Schedule A

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FINANCIAL STATEMENT SCHEDULE A
Name:
Docket No.
MONTHLY SELF-EMPLOYMENT OR BUSINESS INCOME
GROSS MONTHLY RECEIPTS
Monthly Business Expenses
Cost of goods sold
$
Advertising
$
Bad Debts
$
Motor Vehicles:
$
Gas
$
Insurance
$
Maintenance
$
Registration
$
Commissions
$
Depletion
$
Dues and Publications
$
Employee Benefit Programs
$
Freight
$
Insurance (other than health), please specify type of insurance:
$
$
Interest on mortgage to banks
$
Interest on loans
$
Legal and Professional services
$
Office expenses
$
Laundry and cleaning
$
Pension and profit sharing
$
Rent on leased equipment
$
Machinery/Equipment
$
Other business property
$
Repairs
$
$
Supplies
$
Taxes
$
Travel
$
Meals and entertainment
$
Utilities and phones
$
Wages
Other expenses (specify)
$
$
CJ-D 301 Schedule A (4/07)
CGF
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