Tax Year:
Name of proprietor:
Principal business or profession,including product or service (see page C-1 of the instructions):
Business name. If no seperate business name,leave blank:
Business address (including suite or room no.) City town or post office,state,zip:

INCOME
1 Gross receipts or sales:
1x Caution. If this income was reported to you on Form W-2 and the Statutory employee box on that form was checked, see page C-2 and check here:
2 Returns and allowances:
4 Cost of goods sold (from line 42 page 2) :
4a Cost of goods sold:
4b Cost of goods sold:
4c Cost of goods sold:
4d Cost of goods sold:
4e Cost of goods sold:
4f Cost of goods sold:
4g Cost of goods sold:
4h Cost of goods sold:
6 Other income,including Federal and state gasoline or fuel tax credit or refund (see page C-3) (Schedule C, line 19):

EXPENSES
8 Advertising:
9 Bad debts from sales or services (see page C-3):
10 Car and truck expenses (see page C-3):
11 Commissions and fees:
12 Depletion:
13 Depreciation and section 179 expense deduction (not includedin Part III) (see page C-3):
14 Employee benefit programs (other than on line 19) :
15 Insurance (other than health):
16a Interest: Mortgage (paid to banks, etc.):
16b Interest: Other :
18 Office expense:
19 Pension and profit-sharing plans:
20a Rent or lease (see page C-4): Vehicles, machinery, and equipment:
20b Rent or lease (see page C-4): Other business property:
21 Repairs and maintenance:
22 Supplies (not included in Part III):
23 Taxes and licenses:
24a Travel, meals, and entertainment: Travel:
24b Travel, meals, and entertainment: Meals and entertainment:
24c Travel, meals, and entertainment: Enter nondeductible amount included on line 24b(see page C-5):
25 Utilities:
26 Wages (less employment credits):
27a Other expenses :
27b Other expenses :
27c Other expenses :
27d Other expenses :
27e Other expenses :
27f Other expenses :
27g Other expenses :
27h Other expenses :
27i Other expenses :
27j Other expenses :
27k Other expenses :

COST OF GOODS SOLD
35 Inventory at beginning of year. If different from last year's closing inventory, attach explanation:
36 Purchases less cost of items withdrawn for personal use:
37 Cost of labor. Do not include any amounts paid to yourself:
38 Materials and supplies:
39 Other costs:
41 Inventory at end of year: