Get IL 444-2790 2004

Business Income Source IL 444-2790 R-5-04 Date Received Gross Income Business Expenses Expense/ItemPurchased/ Paid to Whom Amount Page 1 of 2 Print Form Reset Form. State of Illinois Department of Human Services 7 PERMANENT SELF-EMPLOYMENT RECORD Client Name Address Caseload Number This self-employment income is for the period of through. Because you are self-employed you are required to report all of your employment income and employment expenses to the eligibility for assistance you must provide us with accurate and complete records of money you take in and the work expenses you pay out. To do this you must write down all money you take in and its source. You must also write down any expenses you had in producing your income. Be sure to include all transactions which occurred during your reporting period. Also save your receipts. Expenses of producing income include but are not limited to things like inventory materials services transportation employee salaries and loan payments. You may choose what month you want to claim an expense but you cannot claim the expense more than once. You may only claim the percentage of the vehicle costs equal to the percentage of mileage that the vehicle is used for business purposes. Depreciation charitable contributions entertainment and personal expenses are NOT allowable business expenses. If you wish you may use this form to keep your records. You are not required to complete this form but you are required to keep accurate records of your self-employment income and expenses. The Department will need a copy of the record you choose to use. If you do complete this form your DHS office will be better able to determine your eligibility for benefits. State of Illinois Department of Human Services 7 PERMANENT SELF-EMPLOYMENT RECORD Client Name Address Caseload Number This self-employment income is for the period of through. Because you are self-employed you are required to report all of your employment income and employment expenses to the eligibility for assistance you must provide us with accurate and complete records of money you take in and the work expenses you pay out. Because you are self-employed you are required to report all of your employment income and employment expenses to the eligibility for assistance you must provide us with accurate and complete records of money you take in and the work expenses you pay out. To do this you must write down all money you take in and its source. You must also write down any expenses you had in producing your income. To do this you must write down all money you take in and its source. You must also write down any expenses you had in producing your income. Be sure to include all transactions which occurred during your reporting period. Also save your receipts. Be sure to include all transactions which occurred during your reporting period. Also save your receipts. Expenses of producing income include but are not limited to things like inventory materials services transportation employee salaries and loan payments. .