Fillable Printable 2011 Form 4H - Wisconsin Department Of Revenue

2011 Form 4H - Wisconsin Department Of Revenue

Corporation Balance Sheets

2011

Wisconsin Corporation

Declaration of Inactivity

Form

1 Cash ..........................................1

2Net trade notes and accounts receivable ...............2

3 Inventories ...................................... 3

4Government obligations ............................4

5Other current assets (attach schedule) ................5

6Loans to stockholders .............................6

7Mortgage and real estate loans ......................7

8Other investments (attach schedule) ..................8

9Netbuildingsandotherxeddepreciableassets .........9

10Netdepletableassets .............................10

11Land (net of any amortization) .......................11

12Intangible assets (amortizable only). . . . . . . . . . . . . . . . . . .12

13Other assets (attach schedule) ......................13

14Total assets ....................................14

15Accountspayable ................................15

16Mortgages,notes,bondspayableinlessthan1year .....16

17Other current liabilities (attach schedule) ...............17

18Loans from stockholders ...........................18

19Mortgages,notes,bondspayablein1yearormore ......19

20Other liabilities (attach schedule) .....................20

21Capitalstock:

a Preferred stock ................................21a

b Common stock ................................ 21b

22Paid-inorcapitalsurplus ...........................22

23Retainedearnings—Appropriated ...................23

24Retainedearnings—Unappropriated .................24

25Adjustments to shareholders’ equity ..................25

26Less:Costoftreasurystock .........................26

27Total liabilities and stockholders’ equity .............27

(a)

Beginning of

Taxable Year

(b)

End of

Taxable Year

IC-046i

.00

DO NOT STAPLE OR BIND

NO COMMAS; NO CENTS

ENTER NEGATIVE NUMBERS LIKE THIS

–1000

NOT LIKE THIS(1000)

For2011ortaxableyearbeginningandending

MY Y C C MY Y C C

MDDMDD

Complete form using BLACK INK.

CorporationName

Number and Street

City State

Due Date: 15thdayof3rdmonthfollowingcloseoftaxableyear.

BStateofIncorporationandYear

AIdentifying Number

C Enter ifyouhaveanextensionoftimetole.Enterextendedduedate.

M D M D Y C C Y

Enter abbrevia-

tion of state in

box,orifa

foreign country,

enterbelow.

ZIP(+4digitsufxifknown)

Y C C Y

Suite Number

Instructions

Tab to navigate within form. Use mouse to check

applicable boxes, press spacebar or press Enter.

Save

Clear

Go to Page 2

28Persontocontactconcerningthisreturn:Name

Telephonenumber()Faxnumber()

General Instructions

Purpose of Form 4H

Acorporationthathasbeencompletelyinactiveboth

in and outside Wisconsin

foranentiretaxable

yearmayleForm4Hinsteadoflingacorporate

franchiseorincometaxreturn.Ifthecorporationisa

combinedgroupmember,itmayleForm4Hinstead

of being included in the combined return. Thereafter,

thecorporationneednotleacorporatefranchiseor

incometaxreturn,beincludedinacombinedreturn,or

leForm4Hforanysubsequentyearunlessrequested

todosobytheDepartmentofRevenueorunless,

inasubsequentyear,thecorporationisactivatedor

reactivated.

Note:BylingForm4H,acorporationisrelievedofthe

requirementtoleanannualfranchiseorincometax

returnwiththeDepartmentofRevenue.Thisexemption

does not extendtoreportsrequiredbyotheragencies.

Inorderforthecorporationtocontinueingoodstanding,

itmustcontinuetoleaWisconsinCorporationAnnual

ReporteachyearwiththeCorporationsBureau,

DivisionofCorporateandConsumerServices,

WisconsinDepartmentofFinancialInstitutions.Failure

tolethisreportwithinaspeciedperiodoftimemay

subjectthecorporationtoadministrativedissolution.

Who May Not File Form 4H

Acorporationmustleacorporatefranchiseorincome

taxreturninsteadofForm4Hineitherofthefollowing

cases:

•Thecorporation’sbalancesheetfortheendofthe

taxableyeardiffersfromitsbalancesheetforthe

beginningofthetaxableyear.

•Thecorporationliquidatesduringthetaxableyear.

Instructions for 2011 Form 4H

When to File

FileForm4Honorbeforethe15thdayofthethirdmonth

followingthecloseofthetaxableyear.Anyextensionof

timeallowedbyeithertheInternalRevenueServiceor

theDepartmentofRevenuetoleyourreturnextends

theduedateforlingForm4H,providedyoucheckline

C,entertheextendedduedate,andattachacopyof

yourextensiontoForm4H.IfForm4Hisnotledon

orbeforetheduedateorextendedduedate,a$150

latelingfeeapplies.

Specic Instructions

Identifying Number

Entereitherofthefollowing:federalemployer

identicationnumber(EIN)orWisconsintaxnumber

(WTN).AfederalEINisnotrequiredtolethisformif

youhaveaWTN.

Balance Sheets

Completethebalancesheetsfortherstdayandlast

dayofthetaxableyearindicatedatthetopofForm4H.

Ifthecorporationhadnoassetsorliabilitiesandcapital

oneithertherstdayorthelastdayofthetaxableyear,

enterzero(0)online14andonline27.

Signature on Form 4H

ThecorporationpresidentmustsignForm4Hifthe

presidentisaresidentofWisconsin.Otherwise,another

ofcerwhoisaWisconsinresidentshouldsignForm

4H.IfnoneoftheofcersareresidentsofWisconsin,

Form4Hmaybesignedbyanydulyauthorizedofcer.

I,theundersignedauthorizedofcer,declarethattheabovenamedcorporationhashadnoincomeorexpenseandhasbeencompletely

inactivefortheentiretaxableyearshownabove.Ialsodeclarethattheabovecorporationbalancesheetsaretrueandcorrect.

Mail to:WisconsinDepartmentofRevenue,POBox8908,Madison,WI53708-8908.

SignatureofOfcer

Title

Date

Ofcer’sStateofResidence

Page 2 of 2

2011Form4H

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