Print and complete this form and mail to:

DHH Acounting & Tax Services

5417 South Florida Ave.

Lakeland, FL 33813-2523

Telephone: (863) 646-7440

 

Corporation/Partnership

Name__________________________________dba_____________________________

Federal ID#__________ State ID#__________ County____________________________ Address________________________________________________________________

Taxable year beginning________and ending________Date of incorporation____________

State of incorporation_________________ Exact date business began_________________

___ C-corp. ___ S-corp. ___ Partnership If S-corp., date of election____________________

Business activity ____________________ Product or service _______________________

Please include a copy of prior year tax return if this is not a first year tax return. Also include 2001 year-end financial statement if available.

Please enter all numbers as yearly totals:

Sales

Cash receipts_______________________

Ending accounts receivable____________

Cost of Goods Sold

Cash purchases of inventory________________

Ending accounts payable inventory___________

Ending inventory________________

 

Deductions/expenses

Salary of officers__________________ Other salaries and wages_______________

Guaranteed payment to partners____________________Repairs and maintenance________________

Bad debts___________________________ Rents_______________________

Taxes and licenses__________________ Interest__________________

Advertising _________________________ Pension/profit sharing plans___________

Employee benefit programs___________ Bank/credit card charges_______________

Car/truck expense___________________ Commissions__________________

Contract services___________________ Entertainment__________________

Freight out_________________________ Insurance____________________

Laundry/uniform_____________________ Office supplies__________________

Operating supplies__________________ Equipment lease__________________

Postage_____________________________ Professional Fees________________

Telephone___________________________ Travel_____________________

Utilities___________________________ Miscellaneous____________________

Other (specify)_____________________ Other (specify)________________________

 

Loans to the corporation for 2001

Total new net loans from each stockholder to corporation (please list name and net amount)

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

 

Total of new loans from others to corporation (incl. vehicles)_______________

Total repayments of loans to others (principle only) _______________

Cash in bank and on hand 12-31-01______________________

Total employee money withheld for 2001_________________

Total employee money paid to IRS/State for 2001_______________

Please list any new equipment and vehicles purchased in 2001--include brief description, date purchased, and total cost of each item.

Description _____________________________Date purchased __________________Cost _____________________

Description _____________________________Date purchased __________________Cost _____________________

Description _____________________________Date purchased __________________Cost _____________________

Description _____________________________Date purchased __________________Cost _____________________

 

S-corps and partnerships -- complete only if this is your 1st year in business or you are adding or subtracting stockholders or partners.

Name & address of stockholder______________________________________________________________

SS# _______________________________________ % business owned _____________________________

Name & address of stockholder______________________________________________________________

SS# _______________________________________ % business owned _____________________________

Name & address of stockholder______________________________________________________________

SS# _______________________________________ % business owned _____________________________

 

Partnerships only:

Name & address of partner___________________________________________________________________

SS# _______________________________________ % business owned ______________________________

money put in _____________________________money taken out __________________________________

Name & address of partner___________________________________________________________________

SS# _______________________________________ % business owned ______________________________

money put in _____________________________money taken out __________________________________

Name & address of partner___________________________________________________________________

SS# _______________________________________ % business owned ______________________________

money put in _____________________________money taken out __________________________________

 

 

C-corps only -- list any corporate income tax payments to IRS in 2001

Date                                         Amount                                         Tax Year

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

 

 

C-corps only list any corporate income tax payments to state in 2001

Date                                         Amount                                         Tax Year

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________