Statement of Self Employment Income - Lone Star Circle of Care 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the name of the person receiving self-employment income in the designated field.
3. Indicate the number of months covered by this income statement. This helps clarify the reporting period for your income.
4. In the section provided, describe what you did to earn this money. Be specific about your business activities.
5. List your business income and expenses in the respective fields. For each entry, include the date, description, and amount.
6. Calculate your total income and total expenses. Enter these amounts in their respective fields.
7. Subtract total expenses from total income to find your total self-employment income. Fill in this final amount.
8. Review all information for accuracy, then sign and date at the bottom of the form to certify its correctness.

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