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4H
Form
Wisconsin Corporation
Declaration of Inactivity
2011
For 2011 or taxable year beginning
and ending
.
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D
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Y
Y
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Due Date: 15th day of 3rd month following close of taxable year.
Complete form using BLACK INK .
Corporation Name
A Identifying Number
and
Year
Number and Street
Suite Number
B State of Incorporation
Enter abbrevia-
tion of state in
ZIP (+ 4 digit suffix if known)
City
State
box, or if a
C
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Y
Y
foreign country,
enter below.
if you have an extension of time to file. Enter extended due date
.
C
Enter
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Corporation Balance Sheets
–1000
ENTER NEGATIVE NUMBERS LIKE THIS
(a)
(b)
(1000)
NOT LIKE THIS
Beginning of
End of
Taxable Year
Taxable Year
NO COMMAS; NO CENTS
.
.
1 Cash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
00
00
.
.
00
2 Net trade notes and accounts receivable . . . . . . . . . . . . . . .
2
00
.
.
3 Inventories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
00
00
.
.
4 Government obligations . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
00
00
.
.
5 Other current assets (attach schedule) . . . . . . . . . . . . . . . .
5
00
00
.
.
6 Loans to stockholders . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
00
00
.
.
7 Mortgage and real estate loans . . . . . . . . . . . . . . . . . . . . . .
7
00
00
.
.
8 Other investments (attach schedule) . . . . . . . . . . . . . . . . . .
8
00
00
9 Net buildings and other fixed depreciable assets . . . . . . . . .
.
.
9
00
00
10 Net depletable assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
.
.
00
00
.
.
11 Land (net of any amortization) . . . . . . . . . . . . . . . . . . . . . . . 11
00
00
.
.
12 Intangible assets (amortizable only) . . . . . . . . . . . . . . . . . . . 12
00
00
.
.
13 Other assets (attach schedule) . . . . . . . . . . . . . . . . . . . . . . 13
00
00
.
.
14 Total assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
00
00
15 Accounts payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
.
.
00
00
16 Mortgages, notes, bonds payable in less than 1 year . . . . . 16
.
.
00
00
.
.
17 Other current liabilities (attach schedule) . . . . . . . . . . . . . . . 17
00
00
.
.
00
00
18 Loans from stockholders . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
.
19 Mortgages, notes, bonds payable in 1 year or more . . . . . . 19
.
00
00
.
.
20 Other liabilities (attach schedule) . . . . . . . . . . . . . . . . . . . . . 20
00
00
21 Capital stock:
.
.
00
a Preferred stock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21a
00
.
.
b Common stock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21b
00
00
22 Paid-in or capital surplus . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
.
.
00
00
23 Retained earnings — Appropriated . . . . . . . . . . . . . . . . . . . 23
.
.
00
00
24 Retained earnings — Unappropriated . . . . . . . . . . . . . . . . . 24
.
.
00
00
.
.
25 Adjustments to shareholders’ equity . . . . . . . . . . . . . . . . . . 25
00
00
26 Less: Cost of treasury stock . . . . . . . . . . . . . . . . . . . . . . . . . 26
.
.
00
00
.
.
27 Total liabilities and stockholders’ equity . . . . . . . . . . . . . 27
00
00
IC-046i
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