Self Employed/Business Profit & Loss Summary Template Form

SMALL BUSINESS PROFIT/LOSS SUMMARY OF INCOME & EXPENSES

Company Name

Tax Year

Todays Date

Date

Type of Business or Profession/Activities

Tax Payers Name

Employer Id Taxpayers Social Security Number

Business Address

City

State

Zip Code

TOTAL INCOME - GROSS SALES

Worker's Comp Insurance

Business or Liability Insurance (Not Health or Auto)

Contract Labor

Cell Phone Business Use

Utilities

Business Meals

Business meals or lunches

Office Expense/Supplies

Interest (Mortgage paid to banks ect:

Commissions and/or Fees Paid

Business Telephone

Legal & Professional Fees

Legal Fee, Accounting & Tax Preparation Fees -Any Professional Fees

Advertising Fees

Auto Mileage -Total Miles Driven For Year (Not Miles for Business-see next)

Total Business Miles Driven

Auto Registration, Taxes or Interest

Auto Insurance

Auto Repairs

Repairs made to vehicle

Auto Maintenance

Tires, Oil Changes, Car Washes, Ect.

Pensions Profit Sharing Plans

Rent or Lease - Equipment/Machinery

Other Rental Business Property

Rents Paid - Office or Commercial Space Rented - House Rent (Home Office)

Wages less employee credits

Wages Paid to Employees

Employee Benefit Program

Taxes and/or Licenses Fee

Subscriptions & Fees

Repairs & Maintenance (Not Auto):

Do not include your auto expenses in this section.

Supplies (Not Included in Cost of Goods):

Travel & Entertainment Expenses:

Other Expenses

List any expenses not listed above

Other Expenses Continued

By signing I am stating that these totals provided are accurate to the best of my accounting abilities and that I have supporting documentation for the income and expenses I the taxpayer has provided. I understand that providing false information could lead to penalties, fines and/or imprisonment. It could also lead to disqualification of participating in any of the bank product programs or advances. You understand that Delta Accounting & Insurance Service Inc. & its staff, employees, tax preparers, and owners/officers are not liable or responsible for any outcome, debts, legal action or errors resulting by the information provided on this form that is personally provided by you the taxpayer. By signing you agree with the following statement.

Taxpayers Signature

Date