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Monthly Self Employment Worksheet
Name
*
First Name
Last Name
Reporting Month
*
Please Select
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February
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September
October
November
December
Social Security Number
Email
*
Confirmation Email
Please enter email address twice
Type of Business
Household Number
Number of Boarders in Household
Average number of hours worked per week at Self-Employment during this reporting period
Income
(Line 1) Gross Income (Including rental / lease of self-employment property sale of goods, services, property and equipment, roomer boarder income)
*
Amount will be Zero "0" unless changed
(Line 2) Returns and Allowances
*
Amount will be Zero "0" unless changed
(Line 3) Gross Profit (Subtract Line 1 from Line 2)
Amount will be Zero "0" unless changed
(Line 4) Other Income, including Capital Gains (Profit from the sale of company assets)
*
Amount will be Zero "0" unless changed
(Line 5) Total Gross Income (Add Lines 3 and 4)
*
Amount will be Zero "0" unless changed
Please attach verification of all income here
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Expenses
(Line 6) Advertising Costs
*
Amount will be Zero "0" unless changed
(Line 7) Bad Debts from sales or services
*
Amount will be Zero "0" unless changed
(Line 8) Vehicle Expenses
*
Amount will be Zero "0" unless changed
(Line 9) Commissions and Fees
*
Amount will be Zero "0" unless changed
(Line 10) Cost of goods sold
*
Amount will be Zero "0" unless changed
(Line 10a) Cost for personal use
*
Amount will be Zero "0" unless changed
(Line 11) Subtract Line 10a from Line 10
Amount will be Zero "0" unless changed
(Line 12) Employee Taxes
*
Amount will be Zero "0" unless changed
(Line 13) Insurance
*
Amount will be Zero "0" unless changed
(Line 14) Loan Payments for assets, equipment, land / property
*
Amount will be Zero "0" unless changed
(Line 15) Taxes and / or Insurance not included in loan
*
Amount will be Zero "0" unless changed
(Line 16) Legal and professional services
*
Amount will be Zero "0" unless changed
(Line 17) Office expenses
*
Amount will be Zero "0" unless changed
(Line 18) Pension and profit sharing plans (Employees)
*
Amount will be Zero "0" unless changed
(Line 19) Rent or Lease
*
Amount will be Zero "0" unless changed
(Line 19a) Vehicles, machinery, and equipment
*
Amount will be Zero "0" unless changed
(Line 19b) Other Business Property
*
Amount will be Zero "0" unless changed
(Line 20) Repairs and maintenance
*
Amount will be Zero "0" unless changed
(Line 21) Supplies and materials
*
Amount will be Zero "0" unless changed
(Line 22) Taxes and licenses for business
*
Amount will be Zero "0" unless changed
(Line 23) Travel, meals, and entertainment
*
Amount will be Zero "0" unless changed
(Line 23a) Travel for business
*
Amount will be Zero "0" unless changed
(Line 23b) Meals and entertainment
*
Amount will be Zero "0" unless changed
(Line 23c) Less cost for personal expense
*
Amount will be Zero "0" unless changed
(Line 24) Subtract Line 23c from Line 23b
Amount will be Zero "0" unless changed
(Line 25) Portion of rent / utilities used as Self Employment expenses
*
Amount will be Zero "0" unless changed
(Line 26) Wages to employees
*
Amount will be Zero "0" unless changed
(Line 27) Total Expenses (Add Lines 6 thru 26)
Amount will be Zero "0" unless changed
(Line 28) Net Profit or (Loss) Subtract Line 27 from Line 5
Amount will be Zero "0" unless changed
Please attach verification of all expenses here
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