Self Employed Income/expenses Page 2

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Balance Sheet Items
Account Type
Financial Institution Name
Account Use Description
Year End Balance
(i.e. Checking, Credit, Lines, Loans, Other)
$
$
$
$
$
$
$
$
NEW EQUIPMENT/CAPITAL IMPROVEMENTS
If during the year you purchased Equipment, Furniture, Vehicles or made Property Improvements, list below (do not duplicate on other side).
Date
Asset Was
If Trade-In Involved
Description
Cost
Purchased
New
Used
Description
Allowance
QUALIFIED DOMESTIC PRODUCTION ACTIVITIES
1. Domestic Production Gross Receipts (DPGR)
$
Qualified Activity Description: _______________________________
1. Gross sales from: tangible personal property, computer software, sound
2. Less: Cost of goods sold for DPGR
recordings, construction, engineering, agricultural services manufactured,
Less: Qualified Deductions
produced or constructed in the U.S.
3. *Direct deductions / expenses for DPGR
4. *Allocated indirect deductions / expenses
2. Identify cost of product directly associated to the activity in # 1
5. Total Qualified Deductions (add lines 2 - 4)
3. Direct Expenses, deductions & losses associated with activity in # 1
Qualified Production Activity Income
(1 minus 5)
4. Allocate indirect expenses & losses not identifiable to any specific gross to
Note: Total DPGR W-2 wages for yr____ x 50%
this and other activities. (Note Allocation Basis)
DEPRECIABLE ASSETS SOLD OR DISPOSED OF
Date
Disposed
Date
Original
Description
Describe Means of Disposal
Amount Received
of
Acquired
Cost
Lunsford Peck, LLC, 5132 N. 300 W. #200, Provo, UT 84604

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Parent category: Financial
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