Self Employed Income/expenses

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SELF EMPLOYED INCOME/EXPENSES
NAME OF OWNER
BUSINESS ACTIVITY
BUSINESS NAME
PRODUCT OR SERVICE
BUSINESS ADDRESS
FEDERAL I.D. NUMBER
1. Business is conducted on the
Cash Basis
Accrual
Other
2. Inventory (if applicable) is based on
Cost
Other
3. Do you use any part of your home for business?
Yes
No
% of Sq/ft
4. Do you have or did you hire any employees?
Yes
No
5. What month did your business start?
What month did it end?
6. Did you buy or sell any assets?
YES
NO (See back for details)
INCOME
COST OF GOODS SOLD (If Applicable)
Gross Receipts/Sales
Beginning of the Year Inventory
Returns & Allowances
(
)
End of the Year Inventory
*Income Reported on 1099's
Purchases
Commissions
Cost of Labor
Interest
Material/Supplies
Other/ K-1's:
Other:
* Do not Duplicate if included in Gross Receipts
EXPENSES
Advertising
Wages (Not Reported Above)
Bad Debts
Payroll Taxes
(if reported as income)
Bank Charges
Social Security & Medicare
Car/Truck Expense (Detail)
Unemployment (Fed & State)
Commissions & Fees Paid
Workers Compensation
Dues & Subscriptions
Other Taxes
Employee Benefit Programs
Real Estate (Business)
Freight
Personal Property (Business)
(Not Included Above)
Health Insurance
Other:
Insurance (Business)
Automobile Exp. (Adequate records required)
Insurance (Business Auto)
Total Miles Driven
Interest (Business {Auto})
Business Miles
Janitorial
Personal Miles
Legal & Professional
Parking Expense
License & Permits
Travel (Out of Town)
Meals (Business)
Transportation (Air Fare)
Office Supplies & Postage
Lodging
Office Expense
Cabs, Bus, Rentals
Officer Compensation
Other:
Outside Services
Meals & Entertainment (at 100%)
Utilities
Meals & Tips
Utilities (Home Office)
Entertainment
Rent (Business)
Tickets & Events
Repairs & Maintenance
Gifts
Security
Gifts
Small Tools
Other/Miscellaneous
Supplies (Other)
Telephone (Business)
Other items (Explain):
List on back, purchases of equipment, furniture, vehicles, or leasehold improvements.
Lunsford Peck, LLC, 5132 N. 300 W. #200, Provo, UT 84604

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