Form M-433B "Statement of Financial Condition for Businesses" - Massachusetts

What Is Form M-433B?

This is a legal form that was released by the Massachusetts Department of Revenue - a government authority operating within Massachusetts. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2014;
  • The latest edition provided by the Massachusetts Department of Revenue;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form M-433B by clicking the link below or browse more documents and templates provided by the Massachusetts Department of Revenue.

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Rev. 10/14
Form M-433B
Massachusetts
Statement of Financial Condition
Department of
for Businesses
Revenue
Business Identification
11 Business name and address
City/Town
State
Zip
12 Mailing address (if different from business address)
City/Town
State
Zip
13 Type of business
4 Phone number
5 Number of employees
16 Type of ownership
Proprietorship 
Partnership 
Corporation 
Other (specify)
17 Federal Identification number (FID)
8 Massachusetts Identification number (if different than FID)
19 Beginning date of business
10 Ending date of business (if closed)
11 Type of Massachusetts corporate excise return last filed
355 
355C 
355S 
355U 
Other (specify)
Year-end date of Massachusetts corporate excise return last filed
Net income reported on Mass. corporate excise return last filed
12 Name of owner, partners, officers
Social Security
Effective
Monthly salary
Total shares
major shareholders, etc.
number
Title
date
or wages
or interest
Assets
13 Total cash on hand (enter also in line 25a)
14 a. Name of bank accounts for general operations,
b.
c.
d.
payroll, savings, certificates of deposits, etc.
Account number
Type of account
Balance
Total balance (add lines 14d; enter total also in line 25b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14d
15 a. Name of issuer of bank line
b.
c.
d.
e.
of credit, credit cards, etc.
Account number
Credit limit
Amount owed
Credit available
Total credit available (add lines 15e; enter total also in line 25c) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15e
Rev. 10/14
Form M-433B
Massachusetts
Statement of Financial Condition
Department of
for Businesses
Revenue
Business Identification
11 Business name and address
City/Town
State
Zip
12 Mailing address (if different from business address)
City/Town
State
Zip
13 Type of business
4 Phone number
5 Number of employees
16 Type of ownership
Proprietorship 
Partnership 
Corporation 
Other (specify)
17 Federal Identification number (FID)
8 Massachusetts Identification number (if different than FID)
19 Beginning date of business
10 Ending date of business (if closed)
11 Type of Massachusetts corporate excise return last filed
355 
355C 
355S 
355U 
Other (specify)
Year-end date of Massachusetts corporate excise return last filed
Net income reported on Mass. corporate excise return last filed
12 Name of owner, partners, officers
Social Security
Effective
Monthly salary
Total shares
major shareholders, etc.
number
Title
date
or wages
or interest
Assets
13 Total cash on hand (enter also in line 25a)
14 a. Name of bank accounts for general operations,
b.
c.
d.
payroll, savings, certificates of deposits, etc.
Account number
Type of account
Balance
Total balance (add lines 14d; enter total also in line 25b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14d
15 a. Name of issuer of bank line
b.
c.
d.
e.
of credit, credit cards, etc.
Account number
Credit limit
Amount owed
Credit available
Total credit available (add lines 15e; enter total also in line 25c) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15e
Assets
(cont’d.)
16 a. Description of real property, including
b.
c.
d.
e.
investment property, unimproved land, etc.
Address
Current market value
Amount owed
Equity in property
Total equity in property (add lines 16e; enter total also in line 25d) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16e
17 a. Description of vehicles,
b.
c.
d.
e.
f. Current
g. Amount
h. Equity
excluding leased vehicles
Make
Model
Year
Tag number
market value
owed
in vehicle
Total equity in vehicle (add lines 17h; enter total also in line 25e) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17h
18 a. Name of
b.
c.
d.
accounts receivable
Date due
Status
Amount due
Total amount due (add lines 18d; enter total also in line 25f) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18d
19 a. Name of proprietor, partner, officer,
b.
c.
d.
e.
shareholder or other receiving loan from business
Relationship
Payoff date
Status
Amount due
Total amount due (add lines 19e; enter total also in line 25g). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19e
Assets
(cont’d.)
20 a. Description of machinery and equipment including
b.
c.
d. Equity in machinery
furniture, fixtures, business machines, etc.
Current market value
Amount owed
and equipment
Total equity in machinery and equipment (add lines 20d; enter total also in line 25h) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20d
21 a. Description of merchandise inventory (goods held for sale and/or
b.
c.
d. Equity in
raw materials used in manufacture, fabrication or production)
Current market value
Amount owed
merchandise
Total equity in merchandise (add lines 21d; enter total also in line 25i) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21d
22 a. Type of security (stocks, bonds, mutual funds,
b.
c. Quantity or
d.
government securities, money market funds, etc.)
Issuer
denomination
Current value
Total balance (add lines 22d; enter total also in line 25j). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22d
Other assets.
Current or appraised value.
23a Notes receivable. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23a
23b Timber, mineral or drilling rights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23b
23c Collectibles, antiques or artwork . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23c
23d Judgments or settlements receivable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23d
23e Patents or copyrights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23e
23f Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23f
23
Total (add lines 23a through 23f; enter also in line 25k). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Liabilities
Liabilities.
Total amount owed. Do not include any mortgages or vehicle loans.
24a Notes payable. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24a
24b Loans payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24b
24c Vehicle lease. Make
Model
. . . . . . . . . . . . . . . . . . . . . . . . 24c
24d Vehicle lease. Make
Model
. . . . . . . . . . . . . . . . . . . . . . . . 24d
24e Bank revolving credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24e
24f Judgments payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24f
24g Past due federal taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24g
24h Past due state taxes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24h
24i Past due other taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24i
24j Equipment leases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24j
24k Other liabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24k
24
Total (add lines 24a through 24k; enter also in line 26) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Net Worth Calculation
Assets
25a Cash on hand . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25a
25b Bank accounts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25b
25c Bank credit available . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25c
25d Real property . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25d
25e Vehicles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25e
25f Accounts receivable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25f
25g Loans from business to proprietor, partners, officers, shareholders or other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25g
25h Machinery and equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25h
25i Merchandise inventory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25i
25j Securities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25j
25k Other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25k
25
Total assets (add lines 25a through 25k) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
26
Liabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
27
Net worth (subtract line 26 from line 25) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Income and Expense Analysis
Income
28
Business income and expenses for (check one):
Fiscal year end (enter date)
Period end (enter date)
Accounting method (check one): 
Cash 
Accrual 
Other (specify)
28a Gross receipts from sales, services, etc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28a
28b Gross rental income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28b
28c Interest income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28c
28d Dividends and capital gain distribution. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28d
28e Royalty income. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28e
28f Commissions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28f
28g Other income (specify) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28g
28h Total income (add lines 28a through 28g) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28h
Expenses
28i Materials purchased . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28i
28j Net wages and salaries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28j
28k Rent or mortgage expenses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28k
28l Installment and lease payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28l
28m Supplies and office expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28m
28n Utilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28n
28o Transportation expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28o
28p Repairs and maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28p
28q Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28q
28r Current taxes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28r
28s Bad debts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28s
28t Travel and entertainment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28t
28u Advertising . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28u
28v Other expenses (specify) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28v
28w Total expenses (add lines 28i through 28v) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28w
29
Net income (subtract line 28w from line 28h). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Other Information
30
Is this business currently in filing compliance with all Massachusetts taxes? 
Yes 
No
If No, identify tax type(s) and period(s)
31
Has this business disposed of any assets or property by sale, transfer, exchange, gift or in any other manner during the past 18 months? 
Yes 
No
If Yes, identify receiving party
32
Is this a foreclosure proceeding pending on any real estate, equipment or other property that this business owns or has an interest in? 
Yes 
No
33
Is another party holding any assets on behalf of this business? 
Yes 
No
If Yes, identify holding party
34
Is this business a party to any lawsuit now pending? 
Yes 
No
35
Is this business currently under bankruptcy court jurisdiction? 
Yes 
No
If Yes, list bankruptcy case number
Under penalties of perjury, I declare that the statement of assets, liabilities and other information in this document, or attached thereto, are true
and correct to the best of my knowledge and belief. I authorize the Massachusetts Department of Revenue to verify any and all information
included in this document.
Signature of taxpayer
Title
Date
Signature of taxpayer
Title
Date
Signature of power of attorney (attach Form M-2848)
Date
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