Form               Wisconsin Corporation
                                         Declaration of Inactivity
                             4H

                                                                                                                                                                                        2024

                       For calendar year 2024 or tax year beginning                              2 0 2 4             and ending            2 0
                                                                           M     M     D   D     Y     Y   Y      Y             M M  D D   Y             Y   Y  Y 
                       Complete form using BLACK INK .                                                                    Due Date:  15th day of 4th month following close of taxable year.
                       Corporation Name                                                                                                  A1  Federal Employer ID Number (FEIN)

                       Number and Street                                                                                  Suite Number   A2  Wisconsin Tax Number (WTN)

                       City                                                                                 State        ZIP (+ 4 digit suffix if known) B  State of Incorporation    and    Year
                                                                                                                                                                  Enter abbreviation 
                                                                                                                                                                  of state in box, or 
DO NOT STAPLE OR BIND C     Enter  if you have an extension of time to file. Enter extended due date                                    .                        if a foreign country, Y  Y Y     Y 
                                                                                                                  M  M  D D  Y  Y   Y  Y                          enter below.

                                                                                           Corporation Balance Sheets
                         ENTER NEGATIVE NUMBERS LIKE THIS  –1000                                                               (a) Beginning of                                   (b) End of
                       NOT LIKE THIS  (1000)              NO COMMAS; NO CENTS                                                    Taxable Year                    Taxable Year
                       1  Cash  ..........................................                                           1                                      .00                                   .00
                       2  Net trade notes and accounts receivable ...............                                    2                                      .00                                   .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
                       18  Loans from stockholders ...........................                                       18                                     .00                                   .00
                       19  Mortgages, notes, bonds payable in 1 year or more  ......                                 19                                     .00                                   .00
                       20  Other liabilities (attach schedule) .....................                                 20                                     .00                                   .00
                       21  Capital stock:
                            a   Preferred stock ................................                                     21a                                    .00                                   .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-046 (R. 6-24)

2024 Form 4H                                                                                               Page 2 of 2

 28  Person to contact concerning this return:  Name
     Telephone number  (        ) Fax number  (        )

 I, the undersigned authorized officer, declare that the above named corporation has had no income or expense and has been completely 
 inactive for the entire taxable year shown above. I also declare that the above corporation balance sheets are true and correct.

 Signature of Officer                                                          Date

 Title                                                                         Officer’s State of Residence

Mail to:  Wisconsin Department of Revenue, PO Box 8908, Madison, WI 53708-8908.

                                  Instructions for Form 4H
General Instructions                                         Who May Not File Form 4H
Purpose of Form 4H                                           A corporation must file a corporate franchise or income 
                                                             tax return instead of Form 4H in either of the following 
A corporation that has been completely inactive both         cases:
in and outside Wisconsin            for  an  entire  taxable 
year  may  file  Form  4H  instead  of  filing  a  corporate •  The corporation’s balance sheet for the end of the 
franchise or income tax return. If the corporation is a      taxable year differs from its balance sheet for the 
combined group member, it may file Form 4H instead           beginning of the taxable year.
of being included in the combined return. Thereafter,        •  The corporation liquidates during the taxable year.
the corporation need not file a corporate franchise or 
                                                             When to File
income tax return, be included in a combined return, or 
file Form 4H for any subsequent year unless requested        File Form 4H on or before the 15th day of the fourth 
to  do  so  by  the  Department  of  Revenue  or  unless,    month  following  the  close  of  the  taxable  year.  Any 
in a subsequent year, the corporation is activated or        extension of time allowed by either the Internal Revenue 
reactivated.                                                 Service or the Department of Revenue to file your return 
                                                             extends the due date for filing Form 4H, provided you 
Note: By filing Form 4H, a corporation is relieved of the 
                                                             check line C, enter the extended due date, and attach 
requirement to file an annual franchise or income tax 
                                                             a copy of your extension to Form 4H. If Form 4H is not 
return with the Department of Revenue. This exemption 
                                                             filed on or before the due date or extended due date, 
does not extend to reports required by other agencies. 
                                                             a $150 late filing fee applies.
In order for the corporation to continue in good standing, 
it must continue to file a Wisconsin Corporation Annual 
Report  each  year  with  the  Corporations  Bureau,         Specific Instructions
Division  of  Corporate  and  Consumer  Services, 
                                                             Identifying Number:  A1 and A2
Wisconsin Department of Financial Institutions. Failure 
to file this report within a specified period of time may    Enter  either  of  the  following:  federal  employer 
subject the corporation to administrative dissolution.       identification number (FEIN) or Wisconsin tax number 
                                                             (WTN). A FEIN is not required to file this form if you 
             Applicable Laws and Rules                       have a WTN.

This document provides statements or interpretations         Balance Sheets
of  the  following  provisions  of  Wisconsin  Statutes  in  Complete the balance sheets for the first day and last 
effect as of June 14, 2024: chs. 71 and 77, Wis. Stats.      day of the taxable year indicated at the top of Form 4H. 
and chs. Tax 1, 2 and 3 Wis. Adm. Code.                      If the corporation had no assets or liabilities and capital 
                                                             on either the first day or the last day of the taxable year, 
                                                             enter zero (0) on line 14 and on line 27.

                                                             Signature on Form 4H
                                                             The corporation president must sign Form 4H if the 
                                                             president is a resident of Wisconsin. Otherwise, another 
                                                             officer who is a Wisconsin resident should sign Form 
                                                             4H. If none of the officers are residents of Wisconsin, 
                                                             Form 4H may be signed by any duly authorized officer.