Document
Financial Statement
ICR 201603-0596-003 · OMB 0596-0082 · Object 63130701.
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Document Metadata
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
|---|---|
| File Title | Financial Statement |
| Last Modified By | Writer |
| File Modified | 2012-09-27 |
| File Created | 2026-10-23 |
| Conversion State | complete |
Extracted Text
PART A. BALANCE SHEET
CURRENT YEAR PAST YEAR THIRD YEAR
(MO/DA/YR) (MO/DA/YR) (MO/DA/YR)
YEAR ENDED
ASSETS
CURRENT ASSETS:
CASH
RECEIVABLES-TRADE
LESS ALLOWANCES FOR DOUBTFUL ACCOUNTS
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INVENTORIES (LIST MAJOR CATEGORIES):
SUPPLIES AND MISCELLANEOUS
MARKETABLE SECURITIES
PREPAID EXPENSES
SUPPLIES INVENTORY
OTHER CURRENT ASSETS:
TOTAL CURRENT ASSETS
FIXED ASSETS:
LAND
BUILDINGS
MACHINERY AND EQUIPMENT
PLANT
LEASEHOLD IMPROVEMENTS
OTHER
LESS ALLOWANCE FOR DEPRECIATION
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BOOK VALUE-FIXED ASSETS
OTHER ASSETS:
DEPOSITS-CASH
DEPOSITS-SECURITIES
TOTAL-OTHER ASSETS
TOTAL ASSETS
LIABLIITIES AND OWNER EQUITY
CURRENT YEAR
PAST YEAR
THIRD YEAR
CURRENT LIABILITIES:
ACCOUNTS PAYABLE-TRADE
ACCRUED PAYROLL
ACCRUED PAYROLL TAXES AND INSURANCE
NOTES PAYABLE
INCOME TAXES-CURRENT
OTHER TAXES
CURRENT PORTION OF LONG-TERM DEBT
OTHER CURRENT LIABILITIES (SPECIFY):
TOTAL CURRENT LIABILITIES
OTHER LIABILITIES:
DEFERRED INCOME TAXES
LOANS FROM OFFICERS/PARTNERS
LONG-TERM OBLIGATIONS-LESS CURRENT AMOUNT
TOTAL OTHER LIABILITIES
TOTAL LIABILITIES
OWNER EQUITY:
CAPITAL STOCK OUTSTANDING
RETAINED EARNINGS (DEFICIT)
PARTNERS' INVESTMENT (DEFICIT)
TOTAL OWNER EQUITY
TOTAL LIABILITIES AND OWNER EQUITY
PART B. SUPPLEMENTAL DATA
THIS STATEMENT IS ON THE-CASH BASIS ACCRUAL BASIS
INVENTORIES ARE-LIFO FIFO COST OR MARKET WHICHEVER IS LOWER
NAMES OF CONTRACTORS OR SUB-CONTRACTORS USED (IF ANY):
PART C. INCOME STATEMENT CURRENT YEAR PAST YEAR THIRD YEAR
GROSS SALES
LESS-RETURNS AND ALLOWANCES
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NET SALES
LESS-COST OF GOODS SOLD
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GROSS PROFIT ON SALES
LESS-SELLING EXPENSE
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NET PROFIT (LOSS) ON SALES
GENERAL EXPENSE:
OFFICERS SALERIES
LEGAL AND OTHER PROFESSIONAL EXPENSE
OFFICE EXPENSE
TOTAL GENERAL EXPENSE
NET OPERATING PROFIT (LOSS)
ADD-OTHER INCOME
LESS-INTEREST EXPENSE
INCOME TAXES
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OTHER EXPENSE
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NET AMOUNT OF OTHER INCOME AND EXPENSE
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NET PROFIT (LOSS) FOR YEAR
NOTE: Offers must set forth full, accurate, and complete information as required in this Financial Statement (including any attachments). The penalty for making false statements in this Financial Statement is prescribed in 18 U.S.C. 1001.
PART D (1). CERTIFICATION FOR CORPORATIONS, LIMITED LIABILITY COMPANIES OR PARTNERSHIPS
We, the undersigned, general officers (or members) of
(Name of corporation, LLC. or partnership) being severally sworn, each declares that the above or attached financial statements are true and correct, and that it covers all of the financial affairs of said company (or) firm up to and including the date of 2 .
CERTIFYING OFFICIAL'S NAME AND TITLE
SIGNATURE (Sign in ink)
DATE
CERTIFYING OFFICIAL'S NAME AND TITLE
SIGNATURE (Sign in ink)
DATE
SWORN TO AND SUBSCRIBED before me this day of (Month/Year).
(Affix Notary Seal)
SIGNATURE
TITLE
PART D (2). CERTIFICATION FOR INDIVIDUALS
I swear (or affirm) that the above or attached financial statements are true and correct to the best of my knowledge.
INDIVIDUAL'S NAME AND TITLE
SIGNATURE (Sign in ink)
DATE
SWORN TO AND SUBSCRIBED before me this day of (Month/Year)
(Affix Notary Seal)
SIGNATURE
TITLE
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