Form 4 - Wisconsin Corporation Franchise Or Income Tax Return - 2012 Page 3
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2012 Form 4
Page
.
Enter total gross receipts from all activities (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . 41
00
41
.
Enter total assets from federal Form 1120 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
00
42
.
Total Wisconsin tangible property (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
00
43
.
Total tangible property (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
00
44
.
Total Wisconsin payroll (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
00
45
Total payroll (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
.
46
00
Total Wisconsin sales, receipts, or premiums included in apportionment ratio (see instructions) 47
.
47
00
Total sales, receipts, or premiums included in apportionment ratio (see instructions) . . . . . . . 48
.
48
00
49
Is the corporation (or any member of the combined group) the sole owner of any limited liability companies?
Yes
No If yes, prepare and submit a list of those LLCs with this return. If this is a combined return, also identify the
corporation that is the sole owner of each LLC.
50
Did you include the income of the LLCs listed for item 49 in this return?
Yes
No
51
Did you (or did any member of the combined group) purchase, license, lease or rent any taxable tangible personal property,
certain coins and stamps, certain leased property affixed to real estate, certain digital goods, or taxable services, for storage, use
or consumption in Wisconsin without paying a state sales or use tax?
Yes
No
52 Person to contact concerning this return:
Phone #:
Fax #
53 City and state where books and records are located for audit purposes:
List the locations of Wisconsin operations:
54
Are any manufacturing facilities located in Wisconsin?
Yes
No
55
56 Did you file federal Schedule UTP – Uncertain Tax Position Statement with the Internal Revenue Service?
Yes
No If yes, enclose federal Schedule UTP with your Wisconsin tax return.
57 Did you file federal Form 8886 – Reportable Transaction Disclosure Statement with the Internal Revenue Service?
Yes
No If yes, enclose federal Form 8886 with your Wisconsin tax return.
Under penalties of law, I declare that this return and all attachments are true, correct, and complete to the best of my knowledge and belief.
Signature of Officer
Title
Date
Preparer’s Signature
Preparer’s Federal Employer ID Number
Date
You must file a copy of your federal return with Form 4, even if no Wisconsin activity.
If this is a combined return, see the instructions for a description of federal return information that must be filed with Form 4.
If you are not filing your return electronically, make your check payable to and mail your return to:
Wisconsin Department of Revenue
PO Box 8908
Madison WI 53708-8908
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