First Name

Last Name

Name of Business

Business Address

Federal EIN

Type of Business

Product / Service

Did you materially participate in the operation of this business during the year?

Yes

Did you start or acquire this business during tax year?

Yes

Did you make any payments during the year that would require you to file form(s) 1099?

Yes

Was the business involved in real estate investment activity during the year?

Yes

Business Income

What were the business gross receipts or sales for the year?

What portion of receipts were reported on Form 1099‐K?

Did you have any other income from this business activity not included in gross receipts above?

Business Expenses

ADVERTISING

RENT

AUTO

BANK FEES AND CHARGES

PHONE

COMPUTERS, EQUIPMENT AND FURNITURE

CONTRACT LABOR

DUES AND SUBSCRIPTIONS

HEALTH INSURANCE

INTERNET SERVICE

INTEREST

LAUNDRY/CLEANING/JANITORIAL

LEGAL AND PROFESSIONAL SERVICES

ENTERTAINMENT

OFFICE EXPENSE

PARKING AND TOLLS

POSTAGE & SHIPPING

PROFESSIONAL EDUCATION & TRAINING

REPAIRS & MAINT.

SOFTWARE

SUPPLIES & SMALL TOOLS

TAXES

ANNUAL CORP. FILING FEES

TRAVEL

UTILITIES

WAGES

OTHER EXPENSES

By signing below I attest that the above-stated information is true, accurate and complete to the best of my knowledge.

Business Owner Signature

Clear

DATE

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