Self-Employment Form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. - Step 1 of 3Full Name *FirstMiddleLastBussiness Name *Type Of Business *Business Address *Address Line 1City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip Code Business purchase Do NextBUSINESS INCOMEBusiness Gross Income ($)MILEAGEDo you have written evidence to support the miles claimed?YesNo Number Of Miles Claimed Business MilesComunting MilesOther MilesBUSINESS EXPENSESAdvertising ($)Legal/Professional Fees ($)Travel Cost (NOT Mileage) ($)Workers Wages (not W2's) ($)Office Expenses ($)Meals ($)Insurance ($)Supplies ($)Utility ($)Interest - Mortgage ($)Equipment Rentals ($)Other Expenses ($)Interest - Others ($)Repairs & Maintenance ($)Internet ($)Taxes & Licences ($)PreviousNextEQUIPMENTDid you purchase any equipment over $500 for your business?YesNoIf yes, please list the item(s) below. Stating the description of equipment, Date acquired, cost of equipment, % the equipment is used by the business, and if it was new or used when purchased.Submit
