Declaration Of Self-Employment Income (Schedule C Due Diligence) - Unlimited Taxes & More, Inc.

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Declaration of Self-Employment Income
(Schedule C Due Diligence)
I, __________________________, declare the following:
1) I am self-employed and my main profession/product is:
______________________________________________________________.
___YES
____
NO
DO YOU WORK FOR YOURSELF?
___YES
____
NO
DO YOU WORK FOR SOMEONE ELSE?
2) The name of my business is:
_____________________________________________________________.
3) Federal ID # (if applicable): _______________________________.
4) I started my business in 20_____. Please initial if applicable (___________)
5) I keep records of my business income and expenses. Please initial (______________)
6) My Gross Sales/Receipts for
20_____
were: _______________________________.
1099 Income
Cash
Credit Card
Check
DO YOU HAVE EXPENSES?
____
YES
____
NO
7) My Business Total Expenses for
20____
were:
$_______
(calculated from BUSINESS EXPENSE WORKSHEET)
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 executed on _____________________, 20________.
SIGNATURE - CUSTOMER
PRINTED NAME - CUSTOMER

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