Expense Submission

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Personal Information

Full Name

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Corporation Name

Leased To

Month JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember

Year

Expenses

Note: Do not record expenses that are deducted from your settlements. If no item expenses, enter "00"

Personally Paid Items

#170 Taxes - Personal Estimates

#205 Taxes - Payroll

#505 Bank & C.C.I.S. Fees

#510 Bonds

#525 Fuel Expenses

#529 Health Insurance

#530 Insurance

#534 Accounting Fees

#540 Motels and Lodging

#545 Office Supplies

#555 Misc Expenses

#560 Permits and License

#565 Postage/Courier Fees

#570 Taxes - Heavy Vehicle Use

#575 Telephone

#580 Tire Expense

#585 Repairs/Parts/Services

#587 Truck Supplies

#590 Truck Wash

#595 Refrigeration Fuel

#600 Unloading/Lumper

#605 Weights and Tolls (Full Amount)

Truck Payment

Trailer Payment

#535 Meals and Incidental Expenses

A. If using per diem rate indicate # Days Out

Other / Comments

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