Form 41 Schedule B-1.1 - Balance Sheet
OMB No.: 2138-0013, Expiration Date: 5/31/2008
Excel
Paperwork Reduction Act Burden Statement
A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB Control Number. The OMB Control Number for this information collection is 2138-0013. Public reporting for Schedule B-1.1, Balance Sheet is estimated to be approximately 2 hours per response, including the time for reviewing instructions, completing and reviewing the collection of information. All responses to this collection of information are mandatory. This report is released to the public unless the respondent receives confidentiality. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Bernie Stankus, OAI/BTS/RITA, RTS-42, 1200 New Jersey Avenue, SE, SW, Washington, D.C. 20590 or e-mail – bernard.stankus@dot.gov.
Air Carrier _____________________
Operation _____________________
Six
Months Ended _____________________, 20_____________________
| |
ASSETS |
|
| |
CURRENT
ASSETS |
|
| Line 1 |
Cash and
cash equivalents |
________________________ |
| Line 2 |
Net Notes
& Accounts Receivable |
________________________ |
| Line 3 |
Other
Current Assets |
________________________ |
| Line 4 |
Total Current Assets |
________________________ |
| |
PROPERTY & EQUIPMENT |
|
| Line 5 |
Owned Property and Equipment |
________________________ |
| Line 6 |
Less Accumulated Depreciation |
________________________ |
| Line 7 |
Leased Property - Capital Leases |
________________________ |
| Line 8 |
Less Accumulated Amortization |
________________________ |
| Line 9 |
Total Property & Equipment |
________________________ |
| Line 10 |
OTHER ASSETS |
________________________ |
| Line 11 |
TOTAL ASSETS |
________________________ |
| |
LIABILITIES & STOCKHOLDER'S EQUITY |
|
| |
CURRENT LIABILITIES |
|
| Line 12 |
Notes and
Accounts Payable |
________________________ |
| Line 13 |
Accrued Taxes |
________________________ |
| Line 14 |
Other Current Liabilities |
________________________ |
| Line 15 |
Total Current Liabilities |
________________________ |
| Line 16 |
LONG TERM DEBT |
________________________ |
| Line 17 |
OTHER
LIABILITIES |
________________________ |
| Line 18 |
DEFERRED
CREDITS |
________________________ |
| |
STOCKHOLDER'S EQUITY: |
|
| Line 19 |
Preferred
Shares Outstanding |
________________________ |
| Line 20 |
Common Shares Outstanding |
________________________ |
| Line 21 |
Other Paid in Capital |
________________________ |
| Line 22 |
Retained Earnings |
________________________ |
| Line 23 |
Total Stockholders' Equity |
________________________ |
| Line 24 |
Less Treasury Stock |
________________________ |
| Line 25 |
Net Stockholders' Equity |
________________________ |
| Line 26 |
TOTAL LIABILITIES & STOCKHOLDERS' EQUITY |
________________________ |
I, the
undersigned, (Title) __________________________________________________ of the
above-named air carrier certify that the above report and the attached
Financial Schedules,
Statement of Operations, and Traffic and Capacity Statistics, including the T-100
report and Passenger Origin-Destination Survey, have been examined by me and to the
best of my knowledge and belief are true, correct and complete reports for
the period stated.
Signature: ____________________________________ Date:
_______________
Name
(Please Type or Print) ________________________________________ BTS Form 41
Schedule B-1.1
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