SELF-EMPLOYMENT AFFIDAVIT
Latoria Jordan
Anderson Expert Tax (A.T.E.)
Birmingham, AL
205-947-8705
Section 1- Personal Information
Full Name:
First Name
Last Name
Date of Birth:
-
Month
-
Day
Year
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:
-
Month
-
Day
Year
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:
Payment Method(s):
Cash
Checks
Zelle
Cash App
Other
Section 4- Affirmation
I,
Signature:
Date:
-
Month
-
Day
Year
Date
Section 5-(Optional Notarization)
State of
County of
day of
Notary Public Signature:
Commission Expires:
205-947-8705
Submit
Should be Empty: