Self- Employment Verification Form (Page 5 of 6) in pdf

Self- Employment Verification Form Page 5

INSTRUCTIONS TO COMPLETE THE STATEMENT OF SELF EMPLOYMENT INCOME

Totals on this worksheet must meet the following criteria:

 A minimum of six weeks of documentation within the most recent six-week period.

 All three totals must be for the same time period

 Must meet IRS guidelines

Calculating *Gross Income:

Gross Receipts are the income you receive from your

business. You should retain supporting documents which

show the amounts and sources of your gross receipts.

$_______________

Examples of documents that show gross receipts include:

Add all gross

receipts for total

 Canceled Checks

gross income.

 Bank deposit slips

 Receipt books

 Invoices

 Credit card charge slips

 Forms 1099-MISC

Calculating *Expenses:

Note: > Expenses may only be deducted from Income with supporting documentation.

Business expenses are the costs you incur to carry on

your business. Your supporting documents should show

the amounts paid for those business expenses.

$_______________

Examples of documents for expenses include:

Add all expenses

for total expenses.

 Receipts

 Account statements

 Credit card slips

 Invoices

 Canceled checks.

Calculating *Total Profit or Loss:

Total profit or loss is equal to gross receipts minus business

$_______________

expenses.

Subtract total expenses

from total gross income

for total profit or loss.

If this document is completed and submitted to the School Readiness Programs along with acceptable supporting

NOTE:

documentation, your self-employment income will be verified. Please discuss verification requirements for self-

employment with your Client Services Specialist.

Verification of Self Employment- rev. 5/10/2016

Self- Employment Verification Form Page 5

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