Profit & Loss Statement
                       Company Name:
                         Owner's Name:
                 Percent of Ownership:                      %
                      Type of Business:
                       Dates Reported:
                                                          (Most recent 3 months)
                                                January          February           March 
           Income 
                             Total Income        $0.00            $0.00             $0.00
           Expenses
                           Total Expenses        $0.00            $0.00             $0.00
                              Net Income         $0.00            $0.00             $0.00
                                                        (Total Income-Total Expenses)
                  Monthly Average Income         $0.00
           By signing this document, I certify that all the information is truthful. I understand that knowing 
           submitted false information may constitute fraud. 
           SIGNATURE                                                                      DATE
                   Business Profit & Loss Statement 
                       Company Name:
                        Owner's Name:
                      Type of Business:
     Please itemize your business revenue and business expenses for one of the 
     following months - April, May, or June. 
                     Business Income            Month: 
                    EXAMPLE: Painting           $                       200.00 
                      Total Income              $                       200.00 
                    Business Expenses           Month: 
                 EXAMPLE: Painting Supplies     $                       120.00 
                     Total Expenses             $                       120.00 
                    Net Monthly Income          $                         80.00 
                                   (Total Income minus Total Expenses)
     By signing this document, I certify that all the information is truthful. I 
     understand that knowing submitted false information may constitute 
     fraud. 
                  SIGNATURE AND DATE