Fillable Declaration of Self-Employment Income (Schedule C Due Diligence)

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Declaration of Self-Employment Income (Schedule C Due Diligence)

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Phone: (785) 827
-
1304
Fax: (785) 827
-
0383
318 W. Cloud St
Salina, KS 67401
www.randjsalinatax.com
Declaration of Self-Employment Income
(Schedule C Due Diligence)
I, ____________________________________, declare the following:
1. I am self-employed, and my main profession/product is:
____________________________________________________________________.
2. The name of my business is:
____________________________________________________________________.
3. Federal ID # (if applicable): ______________________________________________.
4. I started my business in the year of _______________________________________.
5. I keep records of my business income and expenses. Please initial (________)
6. My Gross Sales/Receipts for 2019 were: ___________________________________.
Business Expense Worksheet:
Expense
Description/Details
Advertising Expense
Auto
Expense (fill out
Business Mileage Worksheet)
Mileage Count (fill out Business Mileage Worksheet)
Commission and Fees
Insurance
Legal/Professional Service
Office Expenses
Rent
-
Vehicle, Machinery
Rent
-
Other
Taxes and Licenses
7. My Business Total Expenses for 2019 were: __________________________________________.
By signing this form, I confirm the information I am providing to be accurate and supported by the
necessary documents. I have retained all documents, canceled checks, and other data that form the
basis of income and deductions pertaining to this return.
I declare under penalty of perjury that the foregoing is true and correct.
This document is executed on __________________, 20__.
____________________________________________________________
Print Name
____________________________________________________________
Signature
_____________________
Date
[NOTE: STATUTE DOES NOT REQUIRE NOTARY]
Travel Expenses
Meals and Entertainment
Utilities
Repairs/Maintenance
Employee Wages Paid
Contract Labor or Wages Paid (Specify)
Mortgage
Interest
Prior Depreciation
Other
Other
Other
Other
Other
Days on the Road (ex. Truck Drivers)
Office in Home
–
Total sq. ft. of home
Total sq. footage of office
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Declaration of Self-Employment Income (Schedule C Due Diligence)

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Completed 21 January 2021

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