SELF EMPLOYMENT SHEET
Name
*
First Name
Last Name
Business Profession
Gross Sales (Total Business Income)
*
Business Name
Employer ID Number
Business Physical Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
OPERATING EXPENSES
Advertising
Office Supplies
Commission & Fees
Contract Labor
Insurance
Supplies
Rent
Equipment
Interest
Legal & Professional Fees
Mobile Phone
License & Taxes
Travel Expenses
Meals
Internet Service
Utilities
Employee Wages/Salary
Dues, Subscriptions & Apps
Postage/Freight/Delivery Shipping
Security/Alarm Fees
Education/Seminars
Equipment Lease
For other expenses, enter the amount and a description of the expense
Other Expenses
Other Expenses
Other Expenses
Other Expenses
Other Expenses
Other Expenses
Other Expenses
Other Expenses
Do you have vehicle expenses to report?
Yes
No
VEHICLE INFORMATION
Enter date business use of vehicle started
Number of Business Miles Driven
Gas (Auto Fuel)
Repairs (Vehicle)
Insurance
Lease Payment
Parking & Tolls
Tag & Registration Fees
Do you have Cost of Goods Sold?
Yes
No
Cost of Goods Sold
For Other Expenses, enter the amount and description of the expense
Inventory at the beginning of the year
Inventory at the end of the year
Cost of Labor
Material & Supplies
Purchases
Other Expenses
Other Expenses
Other Expenses
I certify that the information documented is accurate to the best of my knowledge and supported by records kept for the current tax year, and that all listed expenses are related to my business activities.
In the event of an IRS audit, I understand and acknowledge that I am responsible for providing all required receipts and supporting documentation.
Signature
*
Please print your name
*
First Name
Last Name
Last 4 digits of your Social Security Number
*
Date
*
/
Month
/
Day
Year
Date
Submit
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