Federal Democratic Balance Sheet and Annexes

Republic of Ethiopia
Ministry of Revenue Check Filling Status:
Federal Inland o Schedule B Rental Income Tax
Revenue o Schedule C Business Income Tax
Authority o Mining Income Tax
Section 1 – Taxpayer Information
1.Taxpayer's Name (Company Name or Name, Father's 3. Taxpayer Identification Number 8. For the year
Name, Grandfather's Name) ended:
AWENTA CAFÉ AND RESTAURANT PLC 30 SENE
2a. Region 2b. Zone/K-Ketema 4. Tax Account Number Document Number (Official06
UseE.C
Only)
ADDIS ABABA KIRKOS
2c Woreda 2d Kebele/Farmers 2e. House 5. Tax Center
Association Number
2 505/Le Ureal-ERCA small tax payers
6. Telephone Number 7. Fax Number
+251-91-1425034
Section 2- Business Assets, Liabilities and Capital
Instructions: Prior to completing this portion of the Balance Sheet you will need to complete the individual Annexes on the following
three pages be sure and check your filing status at the top of this form.

Assets
1 Cash 10 8,159.75
2 Accounts Receivable (Transfer from Annex 1, Line 4) 20 -
3 Allowance for Bad Debts 30 -
4 Net Accounts Receivable (Subtract Line 3 from Line 2 and Enter Total) 40 -
5 Pre-paid Expenses 50 ###
6 Inventories (Transfer from Annex 2, Line 7) 60 -
7 Operating Supplies 70
8 Other Current Assets (Transfer Total from Annex 3) 80
9 Loans to Shareholders 90
10 Mortgage & Real Estate Loans Receivable 100
11 Other Investments (Transfer Total from Annex 4) 110 -
12 Building, Cost of Improvements & Reconstruction 120 -
Transfer from

13 Computers, Software Products & Related Equipmen 130 -

Annex 5A,
Column f

14 Plant, Machinery, Tools & Other Equipment 140 -

15 Motor Vehicles 150 -
16 Office Equipment and Furniture 160 28,534.05
17 Add Lines 12 through 16 and Enter Total 165 28,534.05
18 Accumulated Depn. (Transfer from Annex 5B, Column d) 170 6,771.23
19 Net Book Value (Subtract Line 18 from Line 17 and Enter Total) 180 21,762.82
20 Intangible Assets (Transfer Total Annex 6A, Column f) 190 -
21 Accumulated Amortization (Transfer Total from Annex 6B, Column f) 200 -
22 Net Book Value / Intangible Assets (Subtract Line 21 from Line 20 and Enter Total) 210 -
23 Other Assets (Transfer Total from Annex 7) 220 -
24 Total Assets (Add Lines 1, 4 through 11, 19, 22 and 23) 230 ###
Liabilities
25 Accounts Payable 240 90,000.00
26 Interest Payable 250
27 Loans Payable Less than 1 year (Transfer Total from Annex 8) 260 -
28 Tax Payable (Transfer Total from Annex 9) 270 (2,313.41)
29 Other Current Liabilities (Transfer Total from Annex 10) 280 12,070.00
30 Loans from Shareholders 290 ###
31 Loans Payable More than 1 Year (Transfer Total from Annex 11) 300 -
32 Other Long Term Liabilities (Transfer Total from Annex 12) 310 -
33 Total Liabilities (Add Lines 25 through 32 and Enter Total) 320 ###
Capital
34 Capital 330 360,000.00
35 Legal Reserve 340
36 Retained Earnings 350 (383,844.45)
37 Total Capital (Add Lines 34 through 36 and Enter Total) 360 ###
38 Total Liabilities and Capital (Add Lines 33 and 37 and Enter Total) 370 ###
Name & Signature of Taxpayer/ Date Seal

Ministry of Revenue Page 1 of 4 (as of 07/08/06) FIRA Form 1302(1/2006)

 Schedule B & C – Business/Rental Tax
Balance Sheet Annexes
Taxpayer Information
1. Taxpayer’s Name ( Company or Individual) 2. Taxpayer Identification 3. For the year
Number ended:
AWENTA CAFÉ AND RESTAURANT PLC 30 SENE 06
E.C

Annex 1- Accounts Receivable

a. Seq.
Num. b. Items Description c. Amount
1 Trade Debtors
2 Sundry Debtors
3 Staff Debtors (Proprietor accounts)
4 Total of Lines 1 through 3 (Enter Total amount on Line 2 of Balance Sheet) -
Annex 2 - Inventories (Applies to Business / Mining Income Only, Not Rental Income)
a. Seq
Num. b. Item Description c. Amount
1 Merchandise Stock
Manufacturing Business
2 Finished/ Processed Product
3 Work in Process
4 Raw Materials
5 Reject, By Product and Other Related Items
6 Spare Parts, Supplies, Packaging and Other Materials
7 Total of Lines 1 through 6, (Enter Total amount on Line 6 of Balance Sheet) -
Annex 3 - Other Current Assets
a. Seq
Num. b. Account Description c. Amount
1

Total ( Enter Total Amount on Line 11 of Balance Sheet(Include Total from Continuation Sheet if Used -
Annex 4 -Other Investments
a. seq
Num. b. Tax Payer Identification Number c. Tax payer Name e. Amount

Total ( Enter Total amount on Line 11 of Balance Sheet (Include Total from Continuation of Sheet if used) -
Annex 5 - Fixed Assets
a. Seq c. Beginning e. Disposal/ f. Ending
Num. b. Item Description d. Addition
Balance Transfer Balance
A. Cost of Fixed Assets (Transfer Column f Totals to Lines 12 through 17 on Balance Sheet)
1 Building, Cost of Improvements & Reconstruction
2 Computers, Software & Related Equipment
3 Plant, Machinery, Tools & Other Equipment 19,565.22 19,565.22
4 Motor Vehicles - -
5 Office Equipment and Furniture 6,652.68 2,316.15 8,968.83
6 Total of Lines 1 through 5 6,652.68 21,881.37 - 28,534.05
B. Depreciation of Fixed Assets (Transfer Column "d" Total to Line 18 of Balance Sheet)
7 Building, Cost of Improvements & Reconstruction
8 Computers, Software & Related Equipment
9 Plant, Machinery, Tools & Other Equipment 3,913.04 3,913.04
10 Motor Vehicles
11 Office Equipment and Furniture 1,330.53 1,527.66 2,858.19
12 Total of Lines 7 through 11 1,330.53 5,440.70 - 6,771.23
13 Net Book Value (Line 6 - Line 12) 5,322.15 21,762.82
Ministry of Revenue Page 2 of 4 (as of 07/08/06) FIRA Form1302 (2/2006
 Schedule B & C – Business/Rental Tax
Balance Sheet Annexes
Taxpayer Information
1. Taxpayer’s Name ( Company or Individual) 2. Taxpayer Identification 3. For the year
Number ended:
AWENTA CAFÉ AND RESTAURANT PLC 30 SENE 06
E.C
Annex 6 - Intangible Assets
a. 'Seq c. Beginning e. Disposal/ f. Ending
No b. Item Description d. Addition
Balance Transfer Balance
A. Intangible Assets (Transfer from Column Totals to Lines 20 on Balance Sheet)
1 Goodwill
2 Patent
3 Leasehold Land
4
5 Other intangible Assets
6 Total of Lines 1 through 5 -
B. Amortization (Transfer Column "f" Total to Line 21 of Balance Sheet)
7 Goodwill
8 Patent
9 Leasehold Land
10
11 Other intangible Assets
12 Total of (Lines 7 through 11) -
13 Net Book Value (Line 6 minus Line 12) -
Annex 7 - Other Assets
a.Seq
Num. b. Account Description c. Amount
1

Total (Enter Total amount on Line 23 of Balance Sheet) -

Annex 8 - Loans Payable in Less than one year
a.Seq
Num b. Name of Loan Provider (Financed by) c. Amount

Total Loans Payable in Less than 1 year (Enter Total amount on Line 27 of Balance Sheet) -
Annex 9 - Tax Payable
a. 'Seq
Num. b. Type of Tax Payable c. Amount
1 Employment Income Tax Payable
2 Business Income Tax Payable
3 Rental Tax Payable
4 Witholding Tax Payable
5 VAT Payable (2,313.41)
6 Turnover Tax Payable
7 Excise Tax Payable
8 Dividend Tax Payable
9 Other Tax Payable
10 Total (Enter Total amount on Line 28 of Balance Sheet (Include Continuation Sheet if Used (2,313.41)

Ministry of Revenue Page 3 of 4 (as of 07/08/06) FIRA Form1302 (2/2006)

/2006)
 Schedule B & C – Business/Rental Tax
Balance Sheet Annexes
Taxpayer Information
1. Taxpayer’s Name ( Company or Individual) 2. Taxpayer Identification 3. For the year
Number ended:
AWENTA CAFÉ AND RESTAURANT PLC 30 SENE 06
E.C
Annex 10 - Other Current Liabilities
a. 'Seq
Num. b. Account Description c. Amount
1 Accruals 12,070.00
2
3
4
5
6
7
8
9
Total (Enter Total amount on Line 28 of Balance Sheet (Include Total from
10 Continuation Sheet if used)) 12,070.00
Annex 11- Loans Payable in more than one year
a. 'Seq Num b. Name of Loan Provider (Financed by) c. Amount

Total (Enter Total amount on Line 30 of Balance Sheet) (Include Total from
Continuation Sheet If used) -
Annex 12- Other Long-Term Liabilities
a. Seq No b. Name of Loan Provider (Financed by) c. Amount
1

Total (Enter Total amount on Line 31 of Balance Sheet) (Include Total from
Continuation Sheet If used) -

Taxpayer Certification
I declare that the above declaration and all information provided here- with is correct and complete. I
understand that any misrepresentations is punishable as per the tax Laws and the Penal Code.
Taxpayer/Authorized Authorized Tax Officer:

Name Name
Seal
Signat Dat Signat
ure e ure
Date

Ministry of Revenue Page 4 of 4 (as of 07/08/06) FIRA Form1302 (2/2006)