Form.php

<?php

class Offline_Store_Block_Adminhtml_Store_Edit_Form extends Mage_Adminhtml_Block_Widget_Form
{

    /**
     * Init form
     */
    public function __construct()
    {
        parent::__construct();
        $this->setId('block_form');
        $this->setTitle(Mage::helper('store')->__('Block Information'));
    }

    protected function _prepareForm()
    {
        $model = Mage::registry('store_block');
        $form = new Varien_Data_Form(
            array(
                'id' => 'edit_form',
                'action' => $this->getUrl('*/*/save',array('store_id'=>$this->getRequest()->getParam('store_id'))),
                'method' => 'post'
            )
        );

        $form->setHtmlIdPrefix('block_');

        $fieldset = $form->addFieldset('base_fieldset', array('legend'=>Mage::helper('store')->__('General Information'), 'class' => 'fieldset-wide'));

        if ($model->getBlockId()) {
            $fieldset->addField('store_id', 'hidden', array(
                'name' => 'store_id',
            ));
        }

        $fieldset->addField('name', 'text', array(
            'name'      => 'name',
            'label'     => Mage::helper('store')->__('Name'),
            'title'     => Mage::helper('store')->__('Name'),
            'required'  => true,
        ));

        $fieldset->addField('short_description', 'textarea', array(
            'name'      => 'short_description',
            'label'     => Mage::helper('store')->__('Short description'),
            'title'     => Mage::helper('store')->__('Short description'),
            'style'     => 'height:16em',
            'required'  => true,

        ));

        $fieldset->addField('description', 'textarea', array(
            'name'      => 'description',
            'label'     => Mage::helper('store')->__('Description'),
            'title'     => Mage::helper('store')->__('Description'),
            'style'     => 'height:16em',
            'required'  => true,

        ));

        $fieldset->addField('position', 'text', array(
            'name'      => 'position',
            'label'     => Mage::helper('store')->__('Position'),
            'title'     => Mage::helper('store')->__('Position'),
            'required'  => true,
        ));

        $fieldset->addField('status', 'select', array(
            'label'     => Mage::helper('store')->__('Status'),
            'title'     => Mage::helper('store')->__('Status'),
            'name'      => 'status',
            'required'  => true,
            'options'   => Mage::getModel('store/source_status')->toArray(),
        ));

        $fieldset->addField('country', 'text', array(
            'name'      => 'country',
            'label'     => Mage::helper('store')->__('Country'),
            'title'     => Mage::helper('store')->__('Country'),
            'required'  => true,
        ));

        $fieldset->addField('state_province', 'text', array(
            'name'      => 'state_province',
            'label'     => Mage::helper('store')->__('State/Province'),
            'title'     => Mage::helper('store')->__('State/Province'),
            'required'  => false,
        ));

        $fieldset->addField('city', 'text', array(
            'name'      => 'city',
            'label'     => Mage::helper('store')->__('City'),
            'title'     => Mage::helper('store')->__('City'),
            'required'  => false,
        ));

        $fieldset->addField('street', 'text', array(
            'name'      => 'street',
            'label'     => Mage::helper('store')->__('Street'),
            'title'     => Mage::helper('store')->__('Street'),
            'required'  => false,
        ));

        $fieldset->addField('zip_code', 'text', array(
            'name'      => 'zip_code',
            'label'     => Mage::helper('store')->__('Zip Code'),
            'title'     => Mage::helper('store')->__('Zip Code'),
            'required'  => false,
        ));

        $fieldset->addField('telephone', 'text', array(
            'name'      => 'telephone',
            'label'     => Mage::helper('store')->__('Telephone'),
            'title'     => Mage::helper('store')->__('Telephone'),
            'required'  => false,
        ));

        $form->setValues($model->getData());
        $form->setUseContainer(true);
        $this->setForm($form);

        return parent::_prepareForm();
    }

}