Free 56920-105_106 (Form4A) - Maryland

STATE OF MARYLAND DEPARTMENT OF ASSESSMENTS AND TAXATION PERSONAL PROPERTY DIVISION FORM 4A

Balance Sheet

2009
Form 4A

Name of Business __________________________________________________________________________ Department ID Number

Example: D12345678

Beginning of Period
month day year month

End of Period
day year

CURRENT ASSETS 1. Cash

ASSETS

WITHIN MARYLAND

TOTAL*

WITHIN MARYLAND

TOTAL*

2. Marketable Securities 3. Accounts Receivable 4. Inventory 5. Other Current Assets PROPERTY, PLANT AND EQUIPMENT 6. Land 7. Buildings 8. Leasehold Improvements 9. Equipment 10. SUBTOTAL Property, Plant and Equipment 11. Accumulated Depreciation 12. Net Property, Plant and Equipment INTANGIBLE AND OTHER ASSETS 13. Intangible 14. Other (provide schedule) 15. TOTAL ASSETS

CURRENT LIABILITIES 16. Accounts Payable

LIABILITIES AND EQUITY

17. Other Current Liabilities LONG TERM LIABILITIES AND EQUITY 18. Mortgage, Notes, Bonds Payable 19. Other Long Term Liabilities 20. Capital Stock 21. Paid in or Capital Surplus 22. Retained Earnings 23. Other 24. TOTAL LIABILITIES AND EQUITY

*Omit TOTAL columns when all assets are located in Maryland.