Form 8621-A - Return By A Shareholder Making Certain Late Elections To End Treatment As A Passive Foreign Investment Company Page 4
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44
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Form 8621-A (12-2013)
Balance Sheet for Election Year
Complete this balance sheet if the shareholder is making election B or D.
Important: Report all amounts in U.S. dollars prepared and translated in accordance with U.S. GAAP. See the
instructions for an exception for DASTM corporations.
(a)
(b)
Assets
Beginning of annual
End of annual
accounting period
accounting period
1
1
Cash
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2a 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
3
Inventories
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Other current assets (attach schedule)
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Loans to shareholders and other related persons .
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Investment in subsidiaries (attach schedule)
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7
Other investments (attach schedule) .
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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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b Less accumulated depletion
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10
Land (net of any amortization) .
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10
11
Intangible assets (see instructions for required attachments):
a Goodwill .
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11a
b Organization costs .
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11b
c Patents, trademarks, and other intangible assets .
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d Less accumulated amortization for lines 11a, b, and c .
11d (
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12
Other assets (attach schedule) .
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Total assets .
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Liabilities and Shareholders’ Equity
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Accounts payable .
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15
Other current liabilities (attach schedule)
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Loans from shareholders and other related persons .
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Other liabilities (attach schedule) .
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18
Capital stock:
a Preferred stock .
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18a
b Common stock .
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18b
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Paid-in or capital surplus (attach reconciliation)
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Retained earnings .
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20
21 (
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Less cost of treasury stock .
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Total liabilities and shareholders’ equity .
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8621-A
Form
(12-2013)
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