FINANCIAL STATEMENT SCHEDULE A
CJ-D 301 Schedule A (4/07)
CGF
Name:
Docket No.
GROSS MONTHLY RECEIPTS
MONTHLY SELF-EMPLOYMENT OR BUSINESS INCOME
Monthly Business Expenses
Cost of goods sold
$
Insurance (other than health), please specify type of insurance:
$
Freight
$
Employee Benefit Programs
$
Dues and Publications
$
Depletion
$
Commissions
$
Registration
$
Maintenance
$
Insurance
Gas
Motor Vehicles:
Bad Debts
Advertising
$
$
Interest on mortgage to banks
$
$
$
$
$
$
$
$
$
Meals and entertainment
$
Travel
$
Taxes
$
Supplies
$
Repairs
$
Other business property
$
Machinery/Equipment
$
Rent on leased equipment
$
Pension and profit sharing
$
Laundry and cleaning
$
Office expenses
$
$
Interest on loans
$
Utilities and phones
Wages
Other expenses (specify)
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FINANCIAL STATEMENT SCHEDULE A
CJ-D 301 Schedule A (4/07)
CGF
WEEKLY BUSINESS INCOME (Gross monthly receipts less total monthly expenses
divided by 4.3.) Enter this amount in Section II, line (d) of CJ-D 301-L or Section
2(d) of CJ-D 301-S.
TOTAL MONTHLY EXPENSES
NATURE OF SELF-EMPLOYMENT OR BUSINESS
Is this business seasonal in nature?
If a seasonal business, please specify percentage of income received and expenses incurred for each month of the year.
Yes
No
1.
2.
MONTH
PERCENTAGE OF INCOME RECEIVED
EXPENSES INCURRED
January
February
March
April
May
June
July
August
September
October
November
December
State whether your business accounts on a calendar year basis or fiscal year basis:
3.
CALENDAR
FISCAL
If your business accounts on a fiscal year basis, give the starting and ending dates of your chosen fiscal year:
4.
starting
ending
State your gross receipts, year to date:
5.
State your gross expenses, year to date:
6.
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