Arizona Administrative Code
Title 14 - PUBLIC SERVICE CORPORATIONS; CORPORATIONS AND ASSOCIATIONS; SECURITIES REGULATION
Chapter 1 - CORPORATION COMMISSION - CORPORATIONS AND ASSOCIATIONS
Article 1 - IN GENERAL
Section R14-1-102 - Annual Reports and Certificates of Disclosure
Current through Register Vol. 30, No. 38, September 20, 2024
A. This rule prescribes, pursuant to A.R.S. § 10-142, the form of the Annual Report and Certificate of Disclosure required to be filed with the Commission under A.R.S. §§ 10-125 and 10-128. This rule does not apply to non-profit corporations.
B. Annual report of domestic and foreign corporations
BALANCE SHEET
YOU MAY SUBSTITUTE FOR THIS BALANCE SHEET AN EXACT COPY OF THE FINANCIAL REPORT TO SHAREHOLDERS AS PROVIDED IN A.R.S. § 10-127, A COPY OF SCHEDULE L, FILED WITH THE INTERNAL REVENUE SERVICE, OR A COPY OF SCHEDULE L, FORM 120 FILED WITH THE ARIZONA DEPARTMENT OF REVENUE FOR THE PURPOSES OF TAXATION OF INCOME PURSUANT TO TITLE 43, ARIZONA REVISED STATUTES.
ASSETS AMOUNT TOTAL
Cash ........................................................................................ --------------------
Trade notes and accounts receivable ................................. --------------------
Inventories ........................................................................... --------------------
Gov't obligations:
Other current assets ............................................................. --------------------
Loans to shareholders .......................................................... --------------------
Mortgage and Real Estate loans .......................................... --------------------
Other investments ................................................................. --------------------
Buildings and other fixed depreciable asset .................... -------------------- --------------------
Depletable assets .................................................................. --------------------
Land (net of any amortization) ............................................ --------------------
Intangible assets (amortizable only) .................................. --------------------
Other assets ........................................................................... --------------------
Total assets ........................................ --------------------
--------------------
LIABILITIES AND CAPITAL
Accounts payable --------------------
Mtges., notes, bonds payable in less than 1 yr. .............. --------------------
Other current liabilities .......................................................... --------------------
Loans from shareholders .................................................... --------------------
Mtges., notes, bonds payable in 1 yr. or more ................... --------------------
Other liabilities ...................................................................... --------------------
Total assets............ --------------------
Capital stock:
Paid-in-or capital surplus .................................................... --------------------
Retained earnings - Appropriated ....................................... --------------------
Retained earnings - Unappropriated ................................. --------------------
Less cost of treasury stock ................................................ --------------------
Total capital...... --------------------
Total liabilities
and Capital.... --------------------
--------------------
3.
Shareholder
Name
Shareholder
Name
Shareholder
Name
Shareholder
Name
Shareholder
Name
Shareholder
Name
Under penalties of law, I declare that I have examined this report, including any attachments, and to the best of my knowledge and belief it is true, correct and complete. (MUST BE SIGNED BY PRESIDENT, VICE PRESIDENT, SECRETARY, ASSISTANT SECRETARY OR TREASURER.)
BY: X BY: X
TITLE: TITLE:
(Date of Signing)
NOTE:
If you are unable to file this Annual Report on or before the date which appears on page 1 of this report, you may, but only on or before that date, file a written request to the Incorporating Division, Annual Report Section for an extension of time, not to exceed 60 days, in which to file this report. The request for an extension of time MUST be accompanied by the annual fee which also appears in part A on page 1 of this report. Only after filing that request and paying the annual fee can the Commission grant this request for extension.
C. Certificate of disclosure
A.R.S. 10-128 CHECK BOX "A" OR "B" WHICHEVER IS APPROPRIATE
THE UNDERSIGNED CERTIFY THAT
No person serving either by election or appointment as officers, directors, trustees, incorporators and persons controlling, or holding more than 10% of the issued and outstanding common shares or 10% of any other proprietary, beneficial or membership interest in the corporation:
The following persons serving either by election or appointment as officers, directors, trustees, incorporators and persons controlling, or holding more than 10% of the issued and outstanding common shares or 10% of any other proprietary, beneficial or membership interest in the corporation, have been or are subject to one or more of the statements listed in items 1 through 3 above:
LISTED MUST ACCOMPANY THIS REPORT.
action, the date and location, the court and public agency
involved, and the file or cause number of the case.
DATED: EXACT CORPORATE NAME:
Under penalties of law, I declare that I have examined this certificate, including any attachments, and to the best of my knowledge and belief it is true, correct and complete. (MUST BE SIGNED BY ANY TWO EXECUTIVE OFFICERS OR DIRECTORS OF THE CORPORATION.)
BY: X _________________________________________________ BY: X _________________________________________________
TITLE: _________________________________________________ TITLE: _________________________________________________
NOTE: Date of signing __________________________________________
Before returning to the Commission, please make sure that you have signed part I AND part J of this report, please make sure that you have checked the appropriate box in part J of this report, and that you have submitted your check or other remittance for the annual fee which is required by law to accompany this report. If you have any questions, please contact the Annual Report Section of the Incorporating Division of the Arizona Corporation Commission.
4.
D. This rule shall be effective December 31, 1977.
