Business Income And Expenses Form Page 3

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BUSINESS INCOME AND EXPENSES
Tools and Equipment purchased this year _____________
Tools and Equipment purchased in prior years and never claimed (make an inventory list with
detail description approx. date purchased and cost) – see worksheet
Travel out of town: Airfare/Transportation__________ Lodging__________ Rental
Car/Taxi/Super shuttle_______________
Uniforms, shoes, safety gear__________
Utilities (do not include home utilities for your home office):
Electric_____________ Water/Sewer________________ Natural Gas____________________
Trash Service__________________________ CAD fees________________________
Wages and payroll expenses (please provide copies of all W-2, W-3, Form 941, 940, and AZ
payroll returns filed for the year)_______________________________
Other expenses- (not shown above):
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I verify that I have accurate books, records and documentation to support the income and
expenses listed.
Signed: ___________________________________ Date: _________________________

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