Declaration of Self-Employment Income (Schedule C Due Diligence)

Declaration of Self-Employment Income (Schedule C Due Diligence)
Who prepared your taxes*
What tax year are you filing?*
I (print your name) First Name* Last Name* , declare the following.
Business Owner Name*

First NameLast Name
Business Name (if the business operates under your personal name, just list your name)*
Contact Number*
E-mail*
example@example.com
Business Address (If you operate from your home, please list the home address)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What industry is your business in or the type of business?*
What is your gross revenue for the referenced tax year ?*
What are your total expenses for the business? *
By signing this form, I certify that the income and expense information provided is true, correct, and complete to the best of my knowledge. I acknowledge that the tax preparer relies solely on the information I provide and is not responsible for verifying, auditing, or independently validating such information.

I understand that I am solely responsible for maintaining adequate books, records, receipts, mileage logs, and other documentation required to substantiate income and deductions. Any estimates or reconstructed records provided are my responsibility and are represented as reasonable and supportable.

I agree that the preparer shall not be held liable for any additional taxes, penalties, interest, or other consequences arising from inaccurate, incomplete, or omitted information I provided. I further agree to indemnify and hold harmless the preparer and firm from any claims or liabilities resulting from my failure to provide accurate or complete information.

I understand that providing false or misleading information may subject me to civil or criminal penalties under federal or state law.

By signing below, I acknowledge my responsibility for the Schedule C income and expenses reported on my tax return.
Print Name*
Signature*

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Date*

MonthDayYear
Date
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