3
Form 5471 (Rev. 12-2012)
Page
Income, War Profits, and Excess Profits Taxes Paid or Accrued (see instructions)
Schedule E
Amount of tax
(a)
(b)
(c)
(d)
Name of country or U.S. possession
In foreign currency
Conversion rate
In U.S. dollars
1
U.S.
2
3
4
5
6
7
8
Total
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▶
Schedule F
Balance Sheet
Important: Report all amounts in U.S. dollars prepared and translated in accordance with U.S. GAAP. See instructions
for an exception for DASTM corporations.
(a)
(b)
Assets
Beginning of annual
End of annual
accounting period
accounting period
1
Cash
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1
2 a Trade notes and accounts receivable .
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2a
2b (
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b Less allowance for bad debts .
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3
Inventories
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3
4
Other current assets (attach statement) .
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4
5
5
Loans to shareholders and other related persons .
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6
6
Investment in subsidiaries (attach statement) .
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7
Other investments (attach statement) .
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7
8 a Buildings and other depreciable assets .
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8a
8b (
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b Less accumulated depreciation
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9 a Depletable assets .
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9a
9b (
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b Less accumulated depletion .
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10
10
Land (net of any amortization) .
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11
Intangible assets:
a Goodwill .
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11a
b Organization costs .
11b
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c Patents, trademarks, and other intangible assets .
11c
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11d (
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d Less accumulated amortization for lines 11a, b, and c .
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12
Other assets (attach statement) .
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12
13
Total assets .
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13
Liabilities and Shareholders’ Equity
14
Accounts payable .
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14
15
Other current liabilities (attach statement)
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15
16
16
Loans from shareholders and other related persons .
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17
Other liabilities (attach statement) .
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17
18
Capital stock:
a Preferred stock .
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18a
b Common stock .
18b
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19
Paid-in or capital surplus (attach reconciliation)
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19
20
Retained earnings .
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20
21 (
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21
Less cost of treasury stock .
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22
Total liabilities and shareholders’ equity . . . . . . . . . . . . . . . .
22
5471
Form
(Rev. 12-2012)