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Tax Year Self-Employement Information

Please fill in all fields that apply to you.
Taxpayer: Spouse:
Type of Business:
(please be specific e.g. if consultant in what field?) 		Type of Business:
(please be specific e.g. if consultant in what field?)
Business Address:
(if different from home) 		Business Address:
(if different from home)
Business Name:
(if not your own name) 		Business Name:
(if not your own name)
EIN Number:
(if applicable) 		EIN Number:
(if applicable)

Self-Employment Income

Tax Payer Spouse
Reported on Form 1099-MISC
Payer Amount Payer Amount
$ $
$ $
$ $
Cash Income $ Cash Income $
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