Part I General Information	Part II Other Income/Deductions
Part III Business Income/Estimated Tax Payments	Part IV Miscellaneous Questions

PART III

Business Income General Information Cash basis  Accrual Basis  First Year  Taxpayer  Spouse Principal Bus./Profession__________________ Business Name__________________ City, State, Zip__________________ Other Accounting Method__________________

Income Gross Receipts or Sales $___________________ Returns and Allowances $ ______________________ Other Income $___________________________

Cost of Goods Sold - If Applicable Inventory at the Beginning of the Year $___________________ Inventory at the End of the Year $ ______________________ Purchases $___________________________ Cost of Items for Personal Use $___________________________ Cost of Labor $___________________________ Materials and Supplies $___________________________ Other Costs $___________________________

Expenses Advertising $___________________ Car and Truck Expense* $ ______________________ Commissions $___________________________ Employee Benefit Programs $___________________________ Insurance (other than health) $___________________________ Health Insurance Premiums for Self* $___________________________ Mortgage Interest(paid to banks, etc.) $___________________________ Other Interest $___________________________ Legal and Professional $___________________________ Office Expense $___________________________ Pension and Profit Sharing Plans $___________________________ Rent - Vehicles, Machinery, and Equipment $___________________________ Rent - Other Business Property $___________________________ Repairs $___________________________ Supplies $___________________________ Taxes - Real Estate $___________________________ Taxes - Other $___________________________ Travel $___________________________ Hot Meals and Entertainment $___________________________ Utilities $___________________________ Wages $___________________________ *Attach detailed schedule

Did you dispose of any business assets (including real estate)? Yes  No If yes, attach detailed schedule.

Did you have a home office during the year? Yes  No Rent $___________________________ Utilities $___________________________ Insurance $___________________________ Janitorial $___________________________ Misc. ___________________________ % of exclusive business use___________________________ IRA Deduction ___________________________ Keogh/SEP Deduction ___________________________

Penalty on Early Withdrawal of Savings ___________________________

Other Income Federal Date Paid Amount Paid Overpayment-Prior Year     1st Quarter     2nd Quarter     3rd Quarter     4th Quarter     State Date Paid Amount Paid Overpayment-Prior Year     1st Quarter     2nd Quarter     3rd Quarter     4th Quarter

Part II | Part IV