SSN/EIN
Business Name
Name
First Name
Last Name
1. Please provide a description of your occupation
A. Type of work
B. Product sold
C. Hours of operation
D. Service provided
E. Where is business conducted
2. Did you receive Form(s) 1099M or 1099K for the income reported?
A. If you did NOT receive Form(s) 1099M or 1099K, can you provide proof of income, if requested?
Yes
No
B. If question 2 is No, please explain business income received.
Customer Description
Charge/Rate
Visits/Day
Total Charge
3. Is a license a requirement of your occupation?
Yes
No
A. Do you have a business license?
Yes
No
4. Federal regulations require you to keep adequate records. What type of records do you maintain to verify business income and expenses. (Check all that apply)
Accounting Records
Computer Records
Paid Invoices/Receipts
Business Stationery
Advertising
Business Bank Accounts
Log Books
Insurance
Others (Please specify)
5. Do you have any expenses?
Yes
No
A. If No, please explain.
6. Do you have business mileage?
Yes
No
B. If 6A is Yes, complete mileage log below.Total business miles
Schedule C Authorization Worksheet
7. Please check only one option from below.
A. Taxpayer did NOT provide documentation to support his/her deduction. must complete Section II
B. Taxpayer DID provide documentation to support his/her deduction. (keep a copy in your file)
Skip Section II. and complete Section III.If Line 7, option A is checked, then this section MUST be completed during the interview with the taxpayer.Gross Receipts (1099M,1099K, received,etc
A. Gross Receipts (1099M,1099K, received,etc.)
Inventory at beginning of year
B. Inventory at beginning of year
Purchases less cost of items withdrawn for personal use
C. Purchases less cost of items withdrawn for personal use
Cost of labor. Do not include any amounts paid to yourself
D. Cost of labor. Do not include any amounts paid to yourself
E. Materials and supplies
F. Other costs
G. Add lines B through F
H. Inventory at end of year
Cost of goods sold (subtract line H from line G)
I. Cost of goods sold (subtract line H from line G)
Total Income (subtract line / from line A)
J. Total Income (subtract line / from line A)
K. Advertising
L. Car and truck expense
Contract labor (if over $600, 1099M(s) must be issued)
M. Contract labor (if over $600, 1099M(s) must be issued)
N. Insurance (other than health)
O. Meals/Per diem (Number of Days)
P. Mileage (business only)
Q. Professional fees
R. Office expense
S. Rent
T. Repairs and maintenance
U. Supplies
V. Taxes and licenses
W. Travel
X. Utilities
Y. Wages
Z. Other Expenses (be specific)
Total Expenses (add lines K through CC)
NET Profit/Loss (subtract line DD from line J)
**Amount must be equal to Line28 of the Schedule C or Line 3 of the Schedule CEZ
9. Additional details, please explain. (if necessary)
In order to comply with federal due diligence regulations, tax preparer's may reasonably reconstruct a taxpayer's income and expenses for the tax year. By signing below, I agree that the information provided is neither inconsistent, incorrect, or incomplete.
Taxpayer's Signature
Date
/
Month
/
Day
Year
Date
Preparer's Signature
Date
/
Month
/
Day
Year
Date
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