First Name Last Name Social Security Business or Profession Professional Code EIN Business Name Phone/Mobile Email Accounting Method(s) Cash Accural OtherSpecify Business AddressAddress City State Zip Code

INCOME

Gross Receipts from Sales $Returns and Allowances $Other Income $Cost of Goods Sold $

EXPENSES

Advertising $Pension & Profit Sharing $Contract Labor $Other Business Property $Employee Benefits $Taxes & Licenses $Mortgage $Deductible Meals & Ent. $Wages $Office Expense $Commission & Fees $Vehicles, Machinery, Equipment $Depreciation $Supplies $Interest $Travel $Legal & Professional Services $Reserves for Future Use $Vehicle Expense $Rent of Lease $Depletion $Repairs & Maintenance $Insurance $Travel, Meals, Ent. $Other $Utilities $Other Expenses $Expenses for Home ONLY: $Sq Ft of Your Home? Sq. Ft.Sq Ft of Home Business? Sq. Ft.Total Expenses $

Cost of Goods Sold

Method Used to Value Closed Inventory: Cost Lower of Cost/Market Other (Attach)Was there any change in determining quantities, cost, or valuations between opening and closing inventory? Yes NoIf Yes, please explain Inventory at Beginning of Year $Purchases $ Cost of Labor $Materials & Supplies $Other Costs $Total $Inventory at End of Year $Cost of Goods Sold $

INFORMATION ON YOUR VEHICLE

When did you place your vehicle in service for business purposes? Business Miles miCommuting Miles miOther Miles miTotal Miles miWas your vehicle used for personal use during off-duty hours? Yes NoDid you or your spouse have another vehicle available for personal use? Yes NoDo you have evidence to support your deduction? Yes NoIf Yes, please explain

Other Expenses Not Listed

Please list any other expenses, NOT previously included in prior sections:

Cell Phone $Internet $Uniforms $Other Expenses Total $If you have any concerns or special requests, briefly explain below so that we can assist you:

Please signs to verify that the information provided is true and accurate to the best of your knowledge and that you are an authorized representative of the business being reported.

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