Monthly Business Operating Statement

 
Case No:__________________________ Debtor(s) Name(s): __________________________ Date Prepared: _______________
   
Receipts and Disburement for Month Ended ___________
   
Gross Receipts:
Amount for Month
1 Gross Sales $______________________
2 Less Cost of Goods Sold $______________________
3 Gross Profit from Sales (subtract line 2 from line 1) $______________________
4 Add Other Income $______________________
5 Gross Income (add lines 3 and 4)
(A)
 $______________________
   
Business Costs and Expenses: (Do not list Chapter 13 Plan payment)  
6 Business Real Property Rent/Lease $______________________
7 Business Real Property Utilities $______________________
8 Salaries/Wages (not included on line 2 above; exclude owner's draw) $______________________
9 Employee Benefits $______________________
10 Payroll Tax Deposits $______________________
11 Sales Tax Deposits $______________________
12 Other Tax Deposits $______________________
13 Auto Expense $______________________
14 Repairs/Maintenance $______________________
15 Insurance on Business (Fire, Theft, Liability, etc) $______________________
16 Workman's Compensation Insurance $______________________
17 Supplies (not included on line 2 above) $______________________
18 Telephone/Internet $______________________
19 Advertising/Promotion $______________________
20 Travel/Entertainment $______________________
21 Professional Fees Paid (Attorney, Accountant, etc) $______________________
22 Other Costs/Expense $______________________
23 Total Business Costs and Expenses for Month
(B)
 $______________________
   
24 Net Income (Loss) for Month (A minus B) $______________________
   
Total Funds On Hand/In Bank At End of Month $______________________
Total Inventory On Hand At End Of Month $______________________
Total Accounts Receivable (Collectible) At End of Month $______________________
Total Accounts Payable At End Of Month $______________________
   
Under penalty of perjury, I(we) declare that the foregoing information is true and correct.
   
   
Signatures: ______________________________________________________________________
Date: __________________
   
   
______________________________________________________________________
 Date: __________________