Tax Year *

Business info

* Name of proprietor * Social Security Number A. Principal business or profession, including product or service (see instructions) B. Enter code from Part IV (Principal Business or Professional Activity Codes) C. Business name. If no separate business name, leave blank D. Employer identification number (EIN), if any E. Business address (number and street). Include suite or room if applicable Apt/Ste No. City State Zip Code

F. Accounting Method Cash Accrual Other

G. Did you materially participate in the operation of this business during this tax year? Yes No

H. Did you started or acquired this business during this tax year Yes No

I. Did you make any payments in this tax year that would require you to file Form(s) 1099? Yes No

Income

1. Gross receipts or sales. See instructions for line 1 and check the box if this income was reported to you on Form W-2 and the “Statutory employee” box on that form was checked

Is the income reported on line 1 reported on Form W-2 and reported as Statutory Employee? Yes No

2. Returns and allowances 3. Subtract line 2 from line 1 4. Cost of goods sold (from line 42) 5. Gross profit. Subtract line 4 from line 3 6. Other income, including federal and state gasoline or fuel tax credit or refund 7. Gross income. Add lines 5 and 6

Expenses

8. Advertising 9. Car and truck expenses 10. Commissions and fees 11. Contract Labor 12. Depletion 13. Depreciation and section 179 expense deduction 14. Employee benefit programs 15. Insurance (other than health) 16a. Mortgage interest 16b. Other interest 17. Legal and professional services 18. Office expense 19. Pension and profit-sharing plans 20a. Rent or lease vehicles 20b. Rent or lease other business property 21. Repairs and maintenance 22. Supplies 23. Taxes and licenses 24a. Travel 24b. Deductible meals 25. Utilities 26. Wages (less employment credits)

Other expenses

Do you have other expenses that are not included from Line 8 to 26? Yes No

Other expense description 1 Other expense amount 1 Other expense description 2 Other expense amount 2 Other expense description 3 Other expense amount 3 Other expense description 4 Other expense amount 4 Other expense description 5 Other expense amount 5 Other expense description 6 Other expense amount 6 Other expense description 7 Other expense amount 7 Other expense description 8 Other expense amount 8 Other expense description 9 Other expense amount 9 27a. Other expenses (from line 48) 27b. Energy efficient commercial bldgs deduction

Home & inventory

28. Total expenses before expenses for business use of home. Add lines 8 through 27a 29. Tentative profit or (loss). Subtract line 28 from line 7

Business use of home method Simplified Method Form 8829 Did not use home for business

31. Net profit or (loss). Subtract line 30 from line 29. If a profit, enter on Schedule 1, line 3

33. Method(s) used to value closing inventory Cost Lower of cost or market Other

34. Change in determining quantities/costs/valuations? Yes No

35. Inventory at beginning of year 36. Purchases less cost of items withdrawn for personal use 37. Cost of labor 38. Cost of materials and supplies 39. Other costs 40. Add lines 35 through 39 41. Inventory at end of year 42. Cost of goods sold

Contact

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