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
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________