Self Employment Affidavit Anderson Expert Tax

SELF-EMPLOYMENT AFFIDAVIT
Anderson Expert Tax (A.T.E.)
7001 Crestwood Blvd, Suite 604

Birmingham, AL 35210
205-617-1180
Section 1- Personal Information
Full Name:

First NameLast Name
Date of Birth:

MonthDayYear
Date
Phone Number:
Format: (000) 000-0000.
Email Address:
example@example.com
Address:
Section 2- Business Information
Business Name (If Applicable):
Type of Work Performed:
Years in Business:
Start Date:

MonthDayYear
Date
Describe the Nature of Your Work/Services Provided:
Section 3-Income Verification
(Estimate your gross income to the best of your knowledge.)
Average Weekly Income:
Average Monthly Income:
Total Income for the Year:
CashChecksZelleCash AppOther
Section 4- Affirmation
I,
Signature:

Clear
Date:

MonthDayYear
Date
Section 5-(Optional Notarization)
State of
County of
day of
Notary Public Signature:

Clear
Commission Expires:
205-617-1180
Should be Empty:

SELF-EMPLOYMENT AFFIDAVIT