tax forms found in
Tax Form Code
Tax Form Name

Pennsylvania Free Printable Statement of Financial Condition for Businesses (REV-484) for 2024 Pennsylvania Statement of Financial Condition for Businesses

It appears you don't have a PDF plugin for this browser. Please use the link below to download 2023-pennsylvania-form-rev-484.pdf, and you can print it directly from your computer.

Statement of Financial Condition for Businesses
Statement of Financial Condition for Businesses (REV-484)

IMPORTANT: FILL IN FORM MUST BE DOWNLOADED ONTO YOUR COMPUTER PRIOR TO COMPLETING (ET+) 03-22 REV-484 STATEMENT OF FINANCIAL CONDITION FOR BUSINESSES If additional space is needed, attach separate sheet SECTION I Start BUSINESS INFORMATION Business Name Business Phone Number ➜ Business Address City County Type of Ownership (select appropriate oval): Sole Proprietor State ZIP Code Corporation Partnership Other Preparer’s Name Preparer’s Title FEIN Type of Business Owner, Partners, Officers, Major Shareholders, etc. Information NAME AND TITLE SECTION II EFFECTIVE DATE HOME ADDRESS PHONE NUMBER TOTAL SHARE OF INTEREST SSN GENERAL FINANCIAL INFORMATION If sole proprietor, include assets and liabilities of owner. Latest Filed PA Income Tax Return Form Tax Year Ended Net Income Before Taxes $ Bank Accounts. (List all types of accounts including payroll and general, saving, certificates of deposit, etc.) NAME OF INSTITUTION ADDRESS TYPE OF ACCOUNT ACCOUNT NUMBER BALANCE $ $ $ $ TOTAL (Enter in Section III, Line 2) $ Reset Entire Form PAGE 1 NEXT PAGE PRINT REV-484 (ET+) 03-22 SECTION II GENERAL FINANCIAL INFORMATION (cont.) Bank credit available. (Lines of credit, etc.) NAME OF INSTITUTION ADDRESS CREDIT LIMIT CREDIT AVAILABLE AMOUNT OWED MONTHLY PAYMENTS $ $ $ $ $ $ $ $ $ $ TOTALS (Enter in Section III, Line 9 or 10 as appropriate.) $ $ $ $ $ Safe Deposit Boxes Rented or Accessed (list all locations, box numbers and contents) BOX NUMBER SAFE DEPOSIT BOX LOCATION CONTENTS Real Estate Property REAL PROPERTY DESCRIPTION TYPE OF OWNERSHIP ADDRESS (INCLUDE COUNTY AND STATE) a. b. c. d. Life Insurance (Owned with business as beneficiary.) NAME INSURED COMPANY POLICY NUMBER TYPE FACE VALUE AVAILABLE LOAN VALUE $ $ $ $ $ $ $ $ TOTALS (Enter in Section III, Line 4.) $ Additional information regarding financial condition (Court proceedings, bankruptcies filed or anticipated, transfers of assets for less than full value, changes in market condition, etc./ include information regarding company participation in trust, estates, retirement plans, etc.) Reset Entire Form PREVIOUS PAGE PAGE 2 NEXT PAGE PRINT REV-484 (ET+) 03-22 GENERAL FINANCIAL INFORMATION (cont.) SECTION II Accounts/notes receivable. Include loans to stockholder, officers, partners, etc. NAME ADDRESS AMOUNT DUE DATE DUE STATUS $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TOTALS (Enter in Section III, Line 3.) $ Reset Entire Form PREVIOUS PAGE PAGE 3 NEXT PAGE PRINT REV-484 (ET+) 03-22 SECTION III ASSETS AND LIABILITIES ANALYSIS (A) ASSET OR LIABILITY (C) CURRENT MARKET VALUE (B) DESCRIPTION (D) LIABILITIES BALANCE DUE (E) AMOUNT OF MONTHLY PAYMENT 1. Cash on hand 2. Bank Accounts 3. Accounts/Notes receivable $ $ $ 4. Life Insurance Loan Value $ $ $ a. $ $ $ b. $ $ $ c. $ $ $ d. $ $ $ a. $ $ $ b. $ $ $ c. $ $ $ a. $ $ $ b. $ $ $ c. $ $ $ a. $ $ $ b. $ $ $ a. $ $ $ b. $ $ $ a. $ $ $ b. $ $ $ c. $ $ $ d. $ $ $ e. $ $ $ f. $ $ $ g. $ $ $ $ $ $ $ $ $ $ $ $ 5. 6. 7. 8. 9. Real Property Vehicles (model, year, license) Machinery and Equipment (Specify) Merchandise Inventory (Specify) Other Assets (Specify) 10. Other Liabilities (Including notes and judgements) $ $ 11. Federal Taxes Owed 12. State Taxes Owed 13. TOTALS Reset Entire Form PREVIOUS PAGE PAGE 4 NEXT PAGE PRINT REV-484 (ET+) 03-22 SECTION IV INCOME AND EXPENSE ANALYSIS The following information applies to income and expenses during the period to Accounting Method Used PART A - INCOME 14. Gross receipts from sales, services, etc. $ 15. Gross rental income $ 16. Interest $ 17. Dividends $ 18. Other income (Specify) $ $ $ $ $ $ $ $ $ $ 19. TOTAL $ PART B - EXPENSES 20. Materials purchased $ 21. Net wages and sales $ 22. Rent $ 23. Installment payments $ 24. Supplies $ 25. Utilities/Telephone $ 26. Gasoline/Oil $ 27. Repairs and maintenance $ 28. Insurance $ 29. Current taxes $ 30. Other (Specify) $ $ $ 31. TOTAL $ 32. Net Difference (Line 19 minus Line 31) SECTION V $ CERTIFICATION Under penalties of perjury, I declare that to the best of my knowledge and belief this statement of assets, liabilities and other information is true, correct and complete. Print Name Reset Entire Form Signature PREVIOUS PAGE PAGE 5 SIGN AFTER PRINTING NEXT PAGE Date PRINT Instructions for REV-484 Statement of Financial Condition for Businesses REV-484 IN (ET+) 03-22 GENERAL INFORMATION The Statement of Financial Condition for Businesses provides the Pennsylvania Department of Revenue with credit and statistical information that will be utilized in evaluating the financial position of your business. Every item of the financial statement must be completed and should reflect accurate statements and amounts. If an item is not applicable to your business, insert N/A. An incomplete Statement of Financial Condition for Businesses will not be considered. The Statement of Financial Condition for Businesses is presented in five sections. Instructions have been provided only for items requiring further clarification. Most of the requested items are self-explanatory and need no further interpretation. LIFE INSURANCE Include all life insurance policies owned by the business, such as Key-Man Life Insurance. ADDITIONAL INFORMATION REGARDING FINANCIAL CONDITION Report any extraordinary situations such as recent transfers of assets, court proceedings and anticipated changes in business income. SECTION III ASSETS AND LIABILITIES ANALYSIS LINES 1-13 This section resembles a balance sheet and should reflect accurate amounts. LINE INSTRUCTIONS LINE 1 SECTION I Report actual cash on hand, not cash in banks or other financial institutions. BUSINESS INFORMATION Please verify the federal employer identification number and the Social Security number(s) of the owner(s). Information about owner, partners, officers, major shareholders, etc. must be completed for any type of ownership indicated. A sole proprietorship must report the individual owner’s name, partnership must report all partners and/or general partner’s names, and corporations must report the names of all corporate officers. Attachments may be used as necessary SECTION II GENERAL FINANCIAL INFORMATION LINE 6 Report the current market value of business vehicles as determined in an automobile “blue book” or by other property valuation sources. LINE 10 Report all debts owed by your business. LINES 11 AND 12 Report all delinquent federal and state business taxes. LINE 13 All information recorded in this section should be verified for accuracy. The department may conduct an inquiry to substantiate this information. Report totals for all entries made in each column. If the business is a partnership, the Statement of Financial Condition for Businesses must be completed for partnership assets and liabilities, and a separate Statement of Financial Condition for Individuals must be completed for each general partner. INCOME AND EXPENSE ANALYSIS BANK CREDIT AVAILABLE Include all credit cards owned by the business. www.revenue.pa.gov RETURN TO FORM SECTION IV LINES 14-32 This section must report all sources of income and all business expenses directly attributable to the production of income. Depreciation is not deemed an out-of-pocket expense and should not be included in the expense summary. Additional lines have been provided for reporting NEXT PAGE REV-484 PRINT 1 income and/or expense items not already itemized in Section III. Each entry should be verified for accuracy. The department may request supporting documents to substantiate this information. REPORTING PERIOD Must reflect an operating period of 12 months. ACCOUNTING METHOD USED Report the accounting method of the business (i.e., cash or accrual). SECTION V CERTIFICATION Signature certifies that statements and entries contained in the Statement of Financial Condition and/or accompanying schedules are correct to the best knowledge and belief of the undersigned. Must provide signature by a duly authorized representative, owner, partner or corporate officer along with the applicable date the signatures were affixed. LINE 19 Report total income from all income sources listed under Lines 14-18. LINE 31 Report total expenses from all liability sources listed under Lines 20-30. 2 REV-484 RETURN TO FORM www.revenue.pa.gov PREVIOUS PAGE PRINT
Extracted from PDF file 2023-pennsylvania-form-rev-484.pdf, last modified April 2022

More about the Pennsylvania Form REV-484 Corporate Income Tax TY 2023

We last updated the Statement of Financial Condition for Businesses in February 2024, so this is the latest version of Form REV-484, fully updated for tax year 2023. You can download or print current or past-year PDFs of Form REV-484 directly from TaxFormFinder. You can print other Pennsylvania tax forms here.

Other Pennsylvania Corporate Income Tax Forms:

TaxFormFinder has an additional 174 Pennsylvania income tax forms that you may need, plus all federal income tax forms.

Form Code Form Name
Form PA-41 PA Fiduciary Income Tax Return
Form PA-40 ES (P/S/F) PA-40 ES Partnership, PA S Corporation and Fiduciary - Declaration of Estimated Withholding Tax
Form RCT-127A Public Utility Realty Tax Report
Form PA-20S-PA-65 S Corporation/Partnership Information Return (PA-20S/PA-65)
Form RCT-900 Public Utility Realty Report By Local Taxing Authorities

Download all PA tax forms View all 175 Pennsylvania Income Tax Forms

Form Sources:

Pennsylvania usually releases forms for the current tax year between January and April. We last updated Pennsylvania Form REV-484 from the Department of Revenue in February 2024.

Show Sources >

About the Corporate Income Tax

The IRS and most states require corporations to file an income tax return, with the exact filing requirements depending on the type of company.

Sole proprietorships or disregarded entities like LLCs are filed on Schedule C (or the state equivalent) of the owner's personal income tax return, flow-through entities like S Corporations or Partnerships are generally required to file an informational return equivilent to the IRS Form 1120S or Form 1065, and full corporations must file the equivalent of federal Form 1120 (and, unlike flow-through corporations, are often subject to a corporate tax liability).

Additional forms are available for a wide variety of specific entities and transactions including fiduciaries, nonprofits, and companies involved in other specific types of business.

Historical Past-Year Versions of Pennsylvania Form REV-484

We have a total of three past-year versions of Form REV-484 in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:

2023 Form REV-484

Statement of Financial Condition for Businesses (REV-484)

2022 Form REV-484

Statement of Financial Condition for Businesses (REV-484)

2021 Form REV-484

Statement of Financial Condition for Businesses (REV-484)

TaxFormFinder Disclaimer:

While we do our best to keep our list of Pennsylvania Income Tax Forms up to date and complete, we cannot be held liable for errors or omissions. Is the form on this page out-of-date or not working? Please let us know and we will fix it ASAP.

** This Document Provided By TaxFormFinder.org **
Source: http://www.taxformfinder.org/pennsylvania/form-rev-484