Declaration of Self Employment Income
Schedule C Due Diligence
By completing this form, I am declaring the following:
I, am
First Name
Last Name
I am self employed
YES
Registered Name of Business
EIN Number
Federal ID Number
EIN Number
What Year Did You Start Your Business
Example 2022
Registered Name of Business
EIN Number
Federal ID Number
If Applicable
What Year Did You Start Your Business
Example 2022
Registered Name of Business
Skip if business is not registered
Federal ID Number (3)
If Applicable
What Year Did You Start Your Business
Example 2022
I keep records of my business income and expenses
YES
I calculated my Gross Sales/ Receipts for 2022 by using
1099 (sent by company worked as an independent contractor)
Bank Statement
Profit/Loss Statement
Other (kept a log, used an app, etcetera)
Profit Amount for 2022
How much did your business earn?
Business Expenses
Please document all expenses which you incurred during the 2022 Tax Year. Make sure to include the amount and a short description if needed. Proof of all expenses should be kept for the next 3 years for tax filing purposes.
Business Mileage (Mileage Count)
Rows
Make and Model of Vehicle
Beginning Odometer Reading
Ending Odometer Reading
Total Vehicle Mileage
Business Use Mileage
Vehicle 1
Vehicle 2
Vehicle 3
Vehicle 4
Days on the Road
Truck Drivers
Car and Truck Expenses
Method of Recordkeeping for Mileage, Third-Party Verification of Odometer Readings Documents will be needed. Discussion of Standard Mileage Rate will take place during your interview with Tax Preparer.
Did you Advertise your Business?
YES
NO
How did you Advertise your Business?
Paid Ad's
Business Cards/Flyers
Website
Paid monthy subscriptions
Word of Mouth
Paid Referral Programs
Advertising Costs
Total Paid
Commission and Fees
Employee Benefits Program
Insurance (other than health)
Interest (Mortgage)
Paid to banks etcetera
Legal and Professional Services
Office Expenses
Pension and Profit Sharing Plans
Rent or Lease (Business Property)
OR Vehicles, Machinery and equipment
Repairs and Maintenance
Supplies
Taxes and Licenses
Travel and Meals
a. Travel b. Deductible meals
Utilities
Contract Labor
Did you have 1099 employees
Salary and Wages (less employment credit)
Of W2 or 1099 employees
Do you have a home office?
YES
NO
What is the Total Square Footage of Home
What is the Square Footage of the Office Space
Dedicated Work Area
Cost of Goods Sold
Materials and Labor used to create the good
Materials and Supplies
additional expense not listed above
Other
additional expense not listed above
Type a question
Other
additional expense not listed above
Other
additional expense not listed above
Total Business Expenses
amount of all expenses listed above
Declaration Statement
I confirm the information I have provided is accurate and supported with the necessary documents. I have retained all documents, cancelled checks, receipts and other data for the basis of income and deductions, pertaining to this return. I declare under penalty of perjury the foregoing is true and correct.
First and Last Name
Typed Name
Signature
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Submit
Should be Empty: