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Get UT DCC 882 2005

ATTACHMENT 3 State of Utah DCC FORM 882 HEAT Program Rev. 05/2005 SELF EMPLOYMENT LEDGER FORM Self Employed Person Case Business Name Month of Social Security Please complete both Part A and Part B. PART A. INCOME RECEIVED Please list all income received from your business in the above month. Entries can be made by jobs completed money received sales and commissions received daily cash receipts etc* You must prove your gross income by bringing in your books ledgers vouchers or other proof* Any barter exchange must be reported as part of your income. List name of payee. PART B. BUSINESS EXPENSE Please list all your business expenses. Business expenses are the cost of doing business. They do not include personal expenses such as income taxes lunches driving to from work. Allowable expenses include labor cost not family members stock rent supplies raw material business taxes and utilities. Bring in receipts canceled checks or other proof of business expense. Must be paid to be allowed* Date Rec* Income Received Amount 1. Total income received this month 3. Total Month s Income Date Pd Business Expense Paid 2. Total expenses paid this month minus Total Month s Expenses MO. NET GROSS INCOME 4. If expenses are more than income enter -0-. If you are a farmer with 1 000 or more in earnings each year enter loss here. 5. If your household has more than one self-employment business total all net gross income from all self employment. The only loss you may enter is a farming loss. Each entry below should have a separate form 882 to each Net Gross Income. 1. Net Gross TOTAL NET GROSS The above is a correct statement of my actual self-employment income and expenses. Customer Signature Date I have reviewed verification and checked off each allowable item with the customer. PART A. INCOME RECEIVED Please list all income received from your business in the above month. Entries can be made by jobs completed money received sales and commissions received daily cash receipts etc* You must prove your gross income by bringing in your books ledgers vouchers or other proof* Any barter exchange must be reported as part of your income. List name of payee. PART B. BUSINESS EXPENSE Please list all your business expenses. Business expenses are the cost of doing business. List name of payee. PART B. BUSINESS EXPENSE Please list all your business expenses. Business expenses are the cost of doing business. They do not include personal expenses such as income taxes lunches driving to from work. Allowable expenses include labor cost not family members stock rent supplies raw material business taxes and utilities. They do not include personal expenses such as income taxes lunches driving to from work. Allowable expenses include labor cost not family members stock rent supplies raw material business taxes and utilities. Bring in receipts canceled checks or other proof of business expense. Must be paid to be allowed* Date Rec* Income Received Amount 1. Bring in receipts canceled checks or other proof of business expense. Must be paid to be allowed* Date Rec* Income Received Amount 1. Total income received this month 3. Total Month s Income Date Pd Business Expense Paid 2. Total expenses paid this month minus Total Month s Expenses MO. .

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