Questionaire for business, rental or farm BUSINESS INCOME(SCHEDULE C)      Farm Income-Cash Method:                 INCOME   2011       2011         Sales Livestock & Other Items Bought for Resale 1   Gross Receipts or Sales 1        Cost or Other Basis 2   Returns and Allowances 2     Sales-Livestock & other prod.              you raised 4   Beginning Inventory 35     Distributions received from Coop. 5   Purchases 36     Non-income items 5-1   Cost of Labor 37     Agricultural Prog. Payments-Cash 6   Materials and Supplies 38     Agricultural Program Payments- 6-1   Other Costs 39     Commodity Credit Loans 7   Ending Inventory 41     Crop Insurance Proceeds 8   Other Income/ Including WFPT 6     Machine Work Income 9                 DEDUCTIONS   2011   Other Income 10   Advertising 8           Bad Debts 9     FARM DEDUCTIONS   2011 Gas & Oil 10           Commissions 11     Chemicals 13   Depletion 12     Conservation Expenses 14   Depreciation 13     Custom Hire 15   Employee Benefit Programs 14     Depreciation 16   Insurance 15     Employee Benefit Program 17   Mortgage Interest Paid 16     Feed Purchased 18   Other Interest 16-1     Fertilizers, Lime 19   Legal & Professional Services 17     Freight, Trucking 20   Office Expenses 18     Gasoline, Fuel, Oil 21   Pension & Profit Sharing Plans 19     Insurance (other than health) 22   Rent on Business Property 20     Mortgage Interest 23   Repairs 21     Other Interest 23-1   Supplies 22     Labor Hired 24   Taxes & Licenses 23     Pension & Profit Sharing 25   Travel 24-1     Rent Equipment 26   100% Meals & Entertainment 24-2     Rent of Farm, Pasture 26-1   Utilities 25     Repairs & Maintenance 27   Wages 26     Seeds, Plants Purchased 28   Other Expenses 27       Storage, Warehousing 29   Mileage       Supplies 30    Do you have documentation?  Yes______  No______   Taxes 31   Truckers:                    # of Days on Road        Utilities 32   Equipment and Other Additions:     Veterinary Fees, Medicine 33   Description Date                          Purchased Amount                   Other (List) 34                                                                           RENTAL INCOME:             Description of Property:__________________________________         Rents Received  $______________________________________   Equipment & Breeding Stock Purchased Deductions:       Description Date        Purchased Amount Advertising         $__________ Other Interest $___________         Auto & Travel     $__________ Repairs $___________         Clean.& Main.     $__________ Supplies $___________         Commissions      $__________ Taxes $___________          Insurance          $__________ Utilities $___________         Legal/Prof. Fees $__________ Other:__________ $___________         Mortgage Int.       $__________  _______________ $___________