FINANCIAL STATEMENT SCHEDULE A Name: Docket No. MONTHLY SELF-EMPLOYMENT OR BUSINESS INCOME GROSS MONTHLY RECEIPTS Monthly Business Expenses Cost of goods sold $ Advertising $ Bad Debts $ Motor Vehicles: $ Gas $ Insurance $ Maintenance $ Registration $ Commissions $ Depletion $ Dues and Publications $ Employee Benefit Programs $ Freight $ Insurance (other than health), please specify type of insurance: $ $ Interest on mortgage to banks $ Interest on loans $ Legal and Professional services $ Office expenses $ Laundry and cleaning $ Pension and profit sharing $ Rent on leased equipment $ Machinery/Equipment $ Other business property $ Repairs $ Supplies $ Taxes $ Travel $ Meals and entertainment $ Utilities and phones $ Wages $ Other expenses (specify) $ $ CJ-D 301 Schedule A (4/07) Page 1 of 2 CGF American LegalNet, Inc. www.FormsWorkflow.com FINANCIAL STATEMENT SCHEDULE A TOTAL MONTHLY EXPENSES WEEKLY BUSINESS INCOME (Gross monthly receipts less total monthly expenses divided by 4.3.) Enter this amount in Section II, line (d) of CJ-D 301-L or Section 2(d) of CJ-D 301-S. $.00 NATURE OF SELF-EMPLOYMENT OR BUSINESS 1. Is this business seasonal in nature? Yes No 2. If a seasonal business, please specify percentage of income received and expenses incurred for each month of the year. MONTH PERCENTAGE OF INCOME RECEIVED EXPENSES INCURRED January February March April May June July August September October November December 3. State whether your business accounts on a calendar year basis or fiscal year basis: CALENDAR FISCAL 4. If your business accounts on a fiscal year basis, give the starting and ending dates of your chosen fiscal year: starting ending 5. State your gross receipts, year to date: 6. State your gross expenses, year to date: CJ-D 301 Schedule A (4/07) Page 2 of 2 CGF American LegalNet, Inc. www.FormsWorkflow.com