Fillable Printable 2012 Form 4H - Wisconsin Department Of Revenue

2012 Form 4H - Wisconsin Department Of Revenue

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

20 Other 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

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

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

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

IC-046i

.00

Corporation Balance Sheets

(a) Beginning of

Taxable Year

(b) End of

Taxable Year

NO COMMAS; NO CENTS

ENTER NEGATIVE NUMBERS LIKE THIS 

–1000

NOT LIKE THIS  (1000)

For2012ortaxableyearbeginning andending

M Y Y C C M Y Y C C

M D D M D D

City State

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

M D M D Y C C Y

ZIP(+4digitsufxifknown)

BStateofIncorporation and Year

Enter abbrevia-

tion of state in

box,orifa

foreign country,

enterbelow.

Y C C Y

2012

Wisconsin Corporation

Declaration of Inactivity

Form

DO NOT STAPLE OR BIND

Complete form using BLACK INK.

CorporationName

Number and Street

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

A1 FederalEmployerIDNumber(FEIN)

Suite Number

 WisconsinTaxNumber(WTN)

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 2012 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: A1 and A2

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

2012Form4H

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