Business Profit and Loss Disclosure Form
2021
Principal Business or Profession
*
Principal Product or Service
Employer ID Number
Ex. format (xxx-xx-xxxx)
Business Name
Business Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Accounting Method
Cash
Accrual
Other
Business Income - Started during 2019
Click here if you started or acquired this business during 2019.
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Business Income - not reported on Form 1099-NEC
Please enter your business income - Gross receipts
Business Expenses - Vehicle Information
Please enter - Year, Make and Model
Business Expenses - Vehicle Expenses
Rows
Business
Commuting
Volunteer
Mileage Used
Business Expenses - Schedule C
Rows
2021
Advertising
Contract Labor
Commissions and fees
Wages
Dependent care benefits
Pensions and profit sharing
Other employee benefits
Office expense
Repairs and maintenance
Supplies
Insurance (excluding health)
Taxes and insurance
Utilities
Vehicle, machinery and equipment rent
Other rent
Travel expenses (excluding meals)
Total meals expense
Legal and professional fees
Mortgage interest
Other interest (including vehicle loan)
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Taxpayer(s) Certifications:
*
I (Taxpayer) certify that the Business expenses provided are true and correct to the best of my knowledge.
I (Taxpayer) have provided true and accurate records to my Tax Professional to prepare my taxes.
I (Taxpayer) understand that my tax return will be prepared using the Business expenses that I have provided.
I (Taxpayer) reserve the right to check my tax return to ensure, that the information and expenses reflects the information I have provided.
I (Taxpayer) understand that I am responsible for maintaining my tax records and receipts for any expenses included in my return.
In the event of an IRS Audit or Review, assistance is available with providing responses to the IRS. However, it is my (Taxpayer) sole responsibility to maintain my tax records and respond timely to any request for information from the IRS.
Signature
*
TAXPAYER CERTIFICATIONS: I (TAXPAYER) CERTIFY I (TAXPAYER) WOULD LIKE MY TAXES PREPARED IN ACCORDANCE WITH THE INFORMATION PROVIDED. I (TAXPAYER) RESERVE THE RIGHT TO CHECK THE RETURN TO MAKE SURE THAT THE INFORMATION ON IT REFLECTS INFORMATION ORIGINALLY GIVEN AND ON THIS QUESTIONAIRE
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
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Signature
*
Any services provided under this agreement must be paid “as Services Rendered”, even if you are under financial obligation to the IRS and/or the state in which you file. Therefore, the amount charged to complete your taxes must be paid, in full, at the time of service.
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