Docstoc

Balance Sheet Form Financial Information

Document Sample
Balance Sheet Form Financial Information Powered By Docstoc
					                                                           Financial Information
                                                                                          Balance Sheet                              Submitted By:                                     e-mail address

       AgChoice Farm Credit, ACA                                                                            Name:

The information set forth below and on the subsequent pages is
submitted for the purpose of obtaining credit and/or including a                                        Address:
lender to make other financial accommodations, all for which
the undersigned is/are willing to become fully liable for
repayment.                                                                                                Phone:
                                                                                                                            Home                              Work                          FAX
                                                                                 Non-Farm Employment Status
Salary                                                     Principal Applicant                                         Other Applicant

Employer's Name
Employer's Address
Type of Business
Position Occupied
Name & Title of Superior
No. of Years in Present Employment
Other Non-Farm Income (Gross)                      $                                                                                     $


                    Balance Sheet as of Date:

                    ASSETS                                                                  Liabilities
 I am the legal owner of the following assets:                                      I owe the following debts:            Purpose            Date      Original                                             Present
                                                                                                                                                                    Interest  Pmts    Periodic
                                                                                                                           of Debt           Incur.    Amount         Rate   Per Year Payment               Balance

Cash                                                                             Income Tax (U.S., State)

Savings                                                                          Taxes (Real Estate, Etc.)

Accounts Receivable                                                              Acc. Payable (Feed-Fert.)

Notes Receivable (current portion)                                               Credit Cards

Feed, Seed and Supplies                    (A)                                   Revolving Credit Line

Investment in Growing Crops (B)

Crops Held for Resale                     (C)                                    Notes Payable

Poultry                                     (D)

Market Livestock                           (E)



Stocks and Bonds                          (J)

Other                                     (H)                                    Accrued Interest

                                                                                 Loans on Life Insurance

                                                                                 Cash Rent

                     CURRENT ASSETS                    $                 -       All Other Current Debts

                                                                                 Principal Portion of IT Debts Due Within Next 12 months

            Autos                       Trucks                                   Principal Portion of LT Debts Due Within Next 12 months

Machinery and Equipment                                                                                                                  CURRENT LIABILITIES                                            $        -
                                                                                                                          Purpose         Incurred    Orig. Amt    Int. Rate Pmts/Yr Payment

Breeding Livestock - Dairy                (F)                                    Notes Payable

Breeding Livestock- Other                 (G)

                                                                                 Equipment Note

Contracts or Notes Receivable                                                    Auto Note

Cash Value Life Insurance



Retirement Accounts

Farm Credit Stock

Farm Credit Allocated Surplus

Other                                      (L)

                                                                                 Other IT debts

            INTERMEDIATE ASSETS                        $                 -
                                                                                 Less Principal Portion of IT Debts Due Within Next 12 months

Farm Land                  Acres                                                                                                         INTERMEDIATE LIABILITIES                                       $        -
Farm Land                  Acres                                                 Farm Mortgage

Farm Land                  Acres                                                 Home Mortgage

Residence

Leasehold Improvements

Contracts or Notes Receivable                                                    OTHER LONG TERM LIABILITIES                                                                  (Sched. I)

Other Real Estate                         (K)                                    Less Principal Portion of LT Debts Due Within Next 12 months
                                                                                                                                         LONG-TERM LIABILITIES                                          $        -
                           FIXED ASSETS                $                 -                                                                     TOTAL LIABILITIES                                        $        -
                    TOTAL ASSETS $                                       -                                                                               NET WORTH                                      $            -


               Contingent Liabilities                                            Certification:
Are any lawsuits pending against you?                                            By signature hereto, the undersigned certifies the information set forth above to be true and correct, containing no material
Have you endorsed or co-signed loans for                                         misrepresentations or omissions. The undersigned consents to any credit investigation necessary to act on or verify the
others?                                                                          foregoing information, and acknowledge that I/We may be asked to supply additional information.
  If so, Amount:
Annual Operating Lease Payments:
Legal Obligations for Child Support:
Any Other Contingent Liabilities:

             Insurance Coverage                                                  _________________________
                    Type   Amount           &     Agency                                             date                                Signature

Life                                                                             _________________________
                                                                                                     date                                Signature
Life
                                                                                 _________________________
Buildings                                                                                            date                                Signature

Equipment                                                                        _________________________
                                                                                                     date                                Signature
Livestock/poultry

Liability
SUPPLEMENTARY BALANCE SHEET SCHEDULES as of:

NAME:

                           Feed, Seed & Supplies (A)                                          Investment in Growing Crops (B)
         Item          Quantity   Units       $/Unit      Value                     Crop       Acres             Invest/Acre    Total
hay                                                                                                      @
                                                                                                         @
                                                                                                         @
                                                                                                         @
                                                                                                         @
                                                                                                         @
                                                                                                         @
                                                                                                         @
                                           Subtotal                                                             Subtotal

                           Crops Held For Resale (C)                                              Market Poultry (D)
       Commodity       Number     Units     Unit Price    Value                  # Layers       Age                            Value




                                                                                    Kind      Number Weight        $/Unit      Value




                                           Subtotal                                                             Subtotal

                           Market Livestock (E)                                                        Dairy Livestock (F)
          Kind         Number Ave. Wt.        $/Unit      Value                     Kind       #Head           $/Head          Value
                                                                           Dairy cows
                                                                           Bulls
                                                                           Bred heifers

                                                                           Yearling heifers

                                                                           Calves



                                           Subtotal                                                             Subtotal

                       Other Breeding Livestock (G)                                           Other Current Assets (H)
         Type          #Head              $/Head          Value                     Item                Unit       $/Unit      Value
Beef   cows
Beef   bulls
Beef   bred heifers
Beef   open heifers
Beef   calves

Sows
Boars
Gilts

                                           Subtotal                                                             Subtotal

                                                                    Other Long-Term Liabilities (I)
                                               Date      Interest                Payments     Periodic Present Proj. Balance   Current
           Creditor / Purpose of debt        Incurred      Rate                   Per Year    Payment Balance Next Year End    Portion




                                                                           Subtotals
SUPPLEMENTARY BALANCE SHEET SCHEDULES as of:

NAME:


                                                            Stocks and Bonds (J)
                                                                                              Number      Value per
                       Stock / Company Name                        Owner                      of Shares     Share       Value




                                                                   Subtotals




                                                 Real Estate Ownership (K)
                                    Location /        Name(s) on                     Number     Year                    Market
     Description of Property        Address              deed          % Ownership   Acres    Acquired       Cost       Value




                                                                   Subtotals




                                    Other Assets (L)
                                                                                                           Cost (if     Market
   Description                                                                                            applicable)   Value




                                                                   Subtotals
                              Income Statement and Projections
                       Your Actuals                                        Your Projections
  For 12 months ending _______________, 20_____                    Year:   Year:              Year:

                        Income                                                Income
 1. Milk Sales __________ lbs.
 2. Crop Sales ________ acres
 3. Contract Sales
 4. Lumber Sales _______ MBF
 5. Timber Sales _______ acres
 6.
 7.
 8.
 9.
                Gross Farm Sales:
                       Expenses                                              Expenses
10. Car and Truck Expenses
11. Chemicals
12. Conservation Expenses
13. Custom Hire
14. Employee Benefits
15. Feed Purchased
16. Fertilizer, Lime
17. Freight, Trucking
18. Gasoline, Fuel, Oil
19. Insurance
20. Labor Hired
21. Pension & Profit Sharing Plan
22. Rent of Machinery & Equip.
23. Rent of Farm, Pasture
24. Repairs, Maintenance
25. Seeds, Plants Purchased
26. Storage, Warehousing
27. Supplies Purchased
28. Real Estate Taxes
29. Utilities
30. Veterinary, Medicine
31. Machine Hire
32. Feeder Cattle/Hog Replace.
33. Dairy or Beef Cattle Replace.
34. Poultry Replacements
35. Miscellaneous Expenses
36. Cost of Goods Sold
37. Sales, General, and Admin.
38.
39.
40.
                   Total Expenses:
Earnings before Interest, Taxes & Living
  Expenses, from Farming Operations

41. Interest Expense
Pre-tax, Pre-living Income from Farming
                Operations

42. Non-Farm Salaries & Wages
43. Interest & Dividends
44. Capital Gains
45. Other Non-Farm Income
46. Social Security Withholding
47. Income Taxes (State/Fed)
48. Living Expenses
49. Other Non-Farm Expenses
                            Subtotal

50. Principal Debt Pmts. (Annual)

        Surplus / (Deficit)

                       List of Projected Capital Purchases:   1.

                                                              2.

                                                              3.

                                                              4.

                                                              5.

				
DOCUMENT INFO
Description: Balance Sheet Form document sample