Free SELF-EMPLOYMENT INCOME WORKSHEET - Partnership - Wisconsin

DEPARTMENT OF HEALTH SERVICES Division of Health Care Access and Accountability F-16036 (05/09)

STATE OF WISCONSIN 7 CFR 273.11 (a)(2)(i)

SELF-EMPLOYMENT INCOME WORKSHEET - Partnership
Tax Year Filing Case Name Worker Name Case Number Worker ID Date Completed

STEP I- CALCULATE PARTNER'S SHARE OF PARTNERSHIP INCOME (1) Enter ordinary business income (2) Add guaranteed payments to partners

Use Schedule K-1 , IRS Form 1065 from line 1 From line 4 (1) $

(2) + $

(3) Add net rental real estate income, other net rental income, interest income, ordinary enter total of lines 2, 3, 5, 6a, 7, 8, 9a, 9c, 10,11 (3) + $ dividends, royalties, net short-term capital gain, net long-term capital gain, net section 1231 gain, other income (4) Equals partner's share of partnership income ( add (1) through (3) ) (4) = $

STEP II - CALCULATE PARTNER'S SHARE OF DEPRECIATION AND DEPLETION. Use IRS Form 1065 (1) Enter depreciation (Enter zero if negative.) (2) Add depletion (Enter zero if negative.) (3) Equals total depreciation and depletion (4) Enter partner's share of ordinary income (loss) (5) Divide (4) by total ordinary income (loss) for partnership (6) Equals partner's percentage in partnership (7) Multiply (6) by total depreciation and depletion (8) Equals partner's share of depreciation and depletion (add (1) plus (2)) from line 16c from line 17 combine (1) and (2) STEP I, (1) above from line 22 divide (4) by (5) from STEP II (3) multiply (6) by (7) (1) $

(2) + $ (3) = $ (4) = $ (5) ÷ (6) = (7) X $ (8) = $

STEP III - CALCULATE PARTNER'S IM-INCOME FROM THE PARTNERSHIP (ADD DEPRECIATION BACK IN) (1) Enter partner's share of partnership income (from STEP I (4), above)

Use results from STEP I and II above (1) $

(2) Add partner's share of depreciation and depletion back in (from STEP II (8), above) (3) Equals partner's IM-Income from partnership (add (1) and (2))

(2) + $ (3) = $ (4) = $

(4) Divide line (3) by the number of months in operation to get the monthly average.

RETAIN COMPLETED FORM IN CASE RECORD

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