Agricultural

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					                                                                    Member FDIC

 800 758-1741 * Toll Free Fax 866 358-6018 * 133 Main Street * PO Box 98 * Hulett, WY 82720
                                    www.summitnb.com




 Agricultural Loan Applicant:

 Due to the Patriot Act and our bank policies, we are required to collect certain
 information from you in order to consider your loan.

 In addition to the loan forms, we will need the following:

         Proof of Income: Include copies of your last three (3) years of income tax
         returns.

         Proof of Physical Address: Include a copy of a form that has your physical
         address on it (i.e. electric bill).

         Proof of Tax Identification: Include a copy of your Social Security Card.

         Proof of Identification by Government issued Picture ID: Include a copy
         of your Drivers License, State ID, or Military ID.

         Proof of Business Identification: If applicable, include a copy of the state
         and/or federal business registration documents.

 If you have any questions while preparing these documents, feel free to call us.

Thank-you for applying for a loan with Summit National Bank.




                                                     Updated 05/04/10. bbe02968-a6b9-416f-9a2e-740b2057510d.xls
Agricultural Loan Application                                                                                                                       Page 2 of 10


                                                                                              AGRICULTURAL LOAN CREDIT APPLICATION
For the purposes of obtaining credit from time to time with the bank, the following statement and information are furnished as a complete, true, and
accurate statement of the financial condition. All amounts are rounded to the nearest $100.
                                                  Financial Statement as of:

                                                                      1. CREDIT TYPE
                     IMPORTANT: Please read these directions before completing this financial statement. Check box that applies.
      If you are applying for individual credit in your own name and are relying on your own income or assets and not the income or assets of another
      person as the basis for repayment of the credit requested, only complete the applicant sections of this financial statement.
      If you are applying for joint credit with another person, complete all sections, providing information about both applicants.
      We intend to apply for joint credit (please initial) Applicant ____________          Co-Applicant ____________
      If you are applying for individual credit, but are relying on income from alimony, child support, or separate maintenance or on the income or
      assets of another person as the basis for repayment of the credit requested, complete all sections to the extent possible, providing information in
      the Co-Applicant sections about the person on whose alimony, child support, or maintenance payments or income/assets you are relying.
     Amount Requested           For How Long      Payment               Want to Repay           Proceeds of Loan to be used for:
                                                                    Monthly         O
                                                                                 Other
                                                                                    t
Applicant                                                       2. APPLICANT INFORMATION                                                         Co-Applicant
Name (include Jr. or Sr. if applicable)                                       Name (include Jr. or Sr. if applicable)

     Social Security No.         Home Phone       Birthdate      Yrs. School         Social Security No.        Home Phone       Birthdate       Yrs. School


    Married         Separate          Dependents (not listed by Co-App)            M
                                                                                   Married         Separate             Dependents (not listed by App)
                                                                                   a
                                                                                   U
    Unmarried (Explain)         No./Age                                            Unmarried      (Explain)     No./Age
                                                                                   n
Address (street, city, state,                                                  Address (street, city,
zip)
                                    Rent      Ow n No.Years                    state, zip)
                                                                                                                    Rent      Ow n No.Years


Applicant                                                      3. EMPLOYMENT INFORMATION                                                         Co-Applicant
       Name & Address of Employer                     Self Employed*                   Name & Address of Employer                      Self Employed*
                                                  Yrs on Job:                                                                    Yrs on Job:
       Yrs. In this line of work or profession:                                    Yrs. In this line of work or profession:
       Position/Title/Type of Business                Business Phone                  Position/Title/Type of Business                 Business Phone

              If employed in current position for less than two years or if currently employed in more than one position, complete the following:
A-Applicant                                                                                                                                         Monthly
                      Previous Employer           City/State    Type of Business          Position/Title               Dates From/To
C-CoApp                                                                                                                                             Income



* Self Employed Borrower(s) may be required to provide additional documentation such as tax returns and financial statements.
                                 4a. ASSETS                                                                 4b. LIABILITIES
                                Current Assets                                                             Current Liabilities
Crops on Hand (Schedule A)                                                     Notes Payable (Due within 1 yr)/Lendor
Growing Crops (Schedule B)
Accounts Receivable (Schedule C)
Feed on Hand (Schedule D)                                                      Credit Cards
Marketable Livestock (Schedule E)                                              Endorsements / Guarantee for Others
Cash on Hand and in Banks                                                      Agricultural Chemicals
Savings                                                                        Fuel
Supplies                                                                       Elevator
Prepaid Expenses                                                               Machinery Dealer
Contracts & Notes Receivable                                                   Other Accounts Payable
                                                                               Cash Rent or Lease Payment Due
                                                                               Real Estate Taxes Payable
                                                                               Income Taxes Payable
                                                                               Medical Expenses




                                       Total Current Assets                                                         Total Current Liabilities


                                                                                                                                         Please Initial
Agricultural Loan Application                                                                                                                        Page 3 of 10

                          4a. ASSETS, Continued                                                    4b. LIABILITIES, Continued
                                                                                                     Intermediate Liabilities
                            Intermediate Assets
                                                                                                    Payment / Due Date / Balance
Production Livestock (Schedule F)                                          Unmatured Debt (Schedule I)
Vehicles, Machinery, Equip; Non-Titled (Schedule G)
Vehicles, Machinery, Equip; Titled (Schedule G)
Irrigation Equipment (Schedule H)
Life Insurance Cash Value
Stocks and Bonds
AUM Grazing Rights Forest/BLM
Retirement Accounts




                                 Total Intermediate Assets                                               Total Intermediate Liabilities
                                                                                                      Long Term Liabilities
                          Long Term/Fixed Assets
                                                                                                    Payment / Due Date / Balance
Real Estate Owned; Farm (Schedule J)                                       Real Estate Mortgages
Real Estate Owned; Non-Farm (Schedule J)
Pensions &/or Annuities (Vested Interest)




                                       Total Fixed Assets                                                    Total Fixed Liabilities
                                        TOTAL ASSETS                                                        TOTAL LIABILITITES
                                            NET WORTH                                                  NET WORTH PERCENTAGE
                                                                                                      NET WORTH and LIABILITIES
                                                                      5. INSURANCE
Company                                                       Agent                                       Email
Phone                                       Fax                               Address
Comments:
                                                                     6. SCHEDULES
Schedule A – CROP ON HAND                                                     Schedule B – GROWING CROPS
         Product          Quantity                Price           Value                Crop           Acres                        Price               Value




                                                      Total                                                                           Total

Schedule C – ACCOUNTS RECEIVABLE                                              Schedule D – FEED ON HANDS
         Product         Quantity                 Price           Value                Kind           Quantity                     Price               Value




                                                      Total                                                                           Total

Schedule E – MARKETABLE LIVESTOCK                                             Schedule F – PRODUCTION LIVESTOCK
           Kind           Number                  Price           Value                 Kind           Number                      Price               Value




                                                      Total                                                                           Total


                                                                                                                                           Please Initial
Agricultural Loan Application                                                                                                                  Page 4 of 10

                                                             6. SCHEDULES, Continued
                                                Schedule G – VEHICLES, MACHINERY & EQUIPMENT
                                  Titled                                                                        Non-Titled
     Make           Model       Description       Year               Value           Make          Model       Description        Year             Value




                                                      Total                                                                          Total

Schedule H – IRRIGATION EQUIPMENT                                                Schedule I – UNMATURED DEBT (1-10 years)
       Description          Make                  Year               Value               Creditor        Payment        Term                      Balance




                                                      Total                                                                          Total

                                                         Schedule J – REAL ESTATE OWNED
                                    Farm                                                                         Non-Farm
     Description/Location          Liens?      Lien Holder           Value           Description/Location        Liens?   Lien Holder              Value
                                    N/Y                                                                           N/Y
                                    N/Y                                                                           N/Y
                                    N/Y                                                                           N/Y
                                    N/Y                                                                           N/Y
                                    N/Y                                                                           N/Y
                                    N/Y                                                                           N/Y
                                                      Total                                                                     Total

                                                     7. ACKNOWLEDGEMENT AND AGREEMENT
    Insurance on Crops                                                           Worker’s Compensation                                        N             Y
    Insurance on Buildings (Fire, Ext Cov.)                                      Estate Plan                                                  N             Y
    Insurance on Machinery, Equipment, Livestock                                 Are any suits pending against you?                           N             Y
    Liability Insurance Coverage                                                 Do you carry health, accident or hospital insurance?         N             Y


BLANKET AUTHORIZATION I certify that everything state in this application and on any attachments is true and correct. I have made no
misrepresentations in this application or with other documents, nor did I omit any pertinent information. I have applied for the loan indicated in this
application to be secured by a first mortgage or deed of trust on the property described herein, and represent that the property will not be used for any
illegal or restricted purpose. I fully understand that it is a Federal crime to knowingly make any false statements when applying for a loan. The Lender
may keep this application whether or not it is approved. I hereby give my consent for information contained in this loan application or in other
documents required in connection with the loan, either before the loan is closed or as part of its quality control program, to be verified or re-verified.
This verification/re-verification may be made by SUMMIT NATIONAL BANK, its agents, successors, and assigns either directly or through a credit
reporting agency. I understand that I must update credit information at Lender’s request if my financial condition changes.

FEDERAL CREDIT APPLICATION INSURANCE DISCLOSURE I have applied for an extension of credit with you. You are soliciting, offering, or selling
me an insurance product or annuity in connection with this extension of credit. FEDERAL LAW PROHIBITS YOU FROM CONDITIONING EXTENSION
OF CREDIT ON EITHER: (1) My purchase of an insurance product or annuity from you or from your affiliates; or (2) My agreement not to obtain, or a
prohibition on me from obtaining, an insurance product or annuity from an unaffiliated entity.

By signing, I acknowledge that I have read and understand both the Blanket Authorization and the Federal Credit Application Insurance Disclosure.



                Applicant's Signature                         Date               Co-Applicant's Signature                    Date
                                                                            PROFIT AND LOSS STATEMENT
                                                                  For:
                                                          Dated as of:
                                 DESCRIPTION                             PRIOR YEAR    CURRENT YEAR
Business Income
   1 Crops, Hay, Pasture, etc.
   2 Timber
   3 Livestock
   4 Cattle:
   5     Steer Calves
   6     Heifer Calves
   7     Steer Yearlings
   8     Cows
   9     Bulls
  10   Sheep:
  11     Lambs
  12     Ewes
  13 Other Ranch Income
  14 ASC, GRP, etc.
  15 Non-Farm Income
                                                    Total Cash Income


Operating Expenses
   1 Auto and Truck Expense
   2 Machinery Hire
   3 Freight and Trucking
   4 Fuel and Oil
   5 Insurance (other than health and life)
   6 Interest
   7 Labor
   8 Cash Rent
   9 Machinery and Equipment Repairs
  10 Supplies
  11 Real Estate Taxes
  12 Utilities ( telephone and electricity)
  13 Legal and Accounting
  14 Pesticides and Spray Materials
  15 Feed
  16 Fertilizer
  17 Seeds Purchased
  18 Livestock and Veterinary
  19 Bank Charges
  20 Other Expenses
                                              Total Operating Expenses
Other Expenses
   21 Family living (including health/life insurance)
   22 Principal Paid on Debts*
   23 Livestock Purchased
   24
   25
                                                     Total Other Expenses


                                                  NET PROFIT/LOSS**




              ____________________________________               ____________________________________
         Signature                            Date             Signature                   Date

       *Do not include operating debt
       **Do not include depreciation
                                                                                         Applicant:                             Period Covered by Plan
                                                           SUMMIT NATIONAL BANK
                                                                                         Address:
                                                              133 Main Street
            Agricultural Cash Flow Statement                     Po Box 98
                                                                                                                                Acres Owned       Total                  Crop
                                                                                         Co-Applicant:
                                                              Hulett, Wy 82720


                                                          JANUARY   FEBRUARY   MARCH         APRIL       MAY      JUNE   JULY     AUGUST      SEPTEMBER   OCTOBER   NOVEMBER    DECEMBER   TOTAL

                                                                                       ESTIMATED CASH AVAILABLE

 1. Beginning Cash (excluding savings)
                              FARM INCOME
 2. Sale of Crops
 3. Sale of livestock and products
 4. Government Payments
 5.
 6.
 7. TOTAL FARM INCOME (Add 2-6)
                             NONFARM INCOME
 8. Off-farm Wages
 9. Interest and Dividends
10.
11. TOTAL NONFARM INCOME (Add 8-10)
                          SALE OF CAPTIAL ITEMS
12. Breeding Stock
13. Machinery and Equipment
14.
15. TOTAL INCOME FROM SALE OF CAPTIAL ITEMS (Add 12+14)
16.
17. TOTAL ESTIMATED CASH AVAILABLE (Add 1+7+11+15+16)

                                                                                   CASH FLOW LOAN PROJECTION

18. Total Estimated Cash Available (17 above)
19. Total Operating (From page 2)
20. Total Interest on OPR
21. Bank Payments
22. Bank Payments
23. Bank Payments
24. Bank Payments
25.
26. ENDING CASH BALANCE (18-(19+24)

                                                                                       ESTIMATED EXPENDITURES

27. Labor
28. Repairs (machinery, equipment, buildings)
29. Rent
30. Seed and Plants
31. Fertilizer and Lime
32. Supplies
33. Livestock Expense (breeding, vet, etc.)
 34. Gas, Oil, Fuel, Electricity, Telephone
 35. Taxes (except income tax)
 36. Insurance (proprty, liability, crop)
 37. Marketing Expense
 38. Feeder Livestock
 39. Breeding Livestock
 40.
 41.
 42.
 43.
 44.
 45.
 46.
 47.
 48.
 49. TOTAL OPERATING EXPENSES (Add 27-48)
 50. Family Living Withdrawals
 51. Nonfarm Business and Investments
 52. Income Tax and Social Security
 53.
 54.
 55.
 56.
 57.
 58.
 59.
 60.
 61.
 62. TOTAL OTHER EXPENSES (Add 50-61)
 63. TOTAL ESTIMATED EXPENDITURES (Add 49+62)




Signature                                       Date   Signature   Date
                                                                   Member FDIC

  800 758-1741 * Toll Free Fax 866 358-6018 * 133 Main Street * PO Box 98 * Hulett, WY 82720
                                      www.summitnb.com



               Agreement to Pay Loan Processing Expenses


  By signing below, I understand there are expenses associated with processing this
 loan. I agree to pay all processing expenses even if the loan applied for is denied or
                                      withdrawn.




Applicant                      Date                 Co-applicant                    Date
                                                                   Member FDIC

  800 758-1741 * Toll Free Fax 866 358-6018 * 133 Main Street * PO Box 98 * Hulett, WY 82720
                                     www.summitnb.com

   We offer Credit Life Insurance and Disability Coverage!



Credit Life Insurance
The following products are available with your loan (single or joint):

       *   GROSS PAY LIFE – Insurance coverage equal to the total of payments
       *   NET PAY LIFE – Insurance coverage equal to the amount financed
       *   DECREASING LIFE – Coverage decreases commensurate with the payment schedule
       *   LEVEL LIFE COVERAGE – Coverage stays the same for the term of the loan




Disability
The following products are available for a single or joint loan that is setup with regular
installment payments (monthly, quarterly, etc.):

       *
           7 DAY RETRO AND 14 DAY RETRO – Full Term customer has to be off for either
           (7) or (14) days, depending on plan chosen, to file for benefits – once qualified
           coverage goes back to the first day of disability

       *   30 DAY ELIMINATION – Full Term – the first 30 days of disability are eliminated

       *   30 DAY ELIMINATION WITH 24 MONTH CRITICAL PERIOD – Same as above

       *   12 MONTH CRITICAL PERIOD – Same as above except there are only 12 benefit
           periods; loan must mature for at least 3 years before insurance can be used

       *   36 MONTH CRITICAL PERIOD – Same as above except there are 36 benefit
           periods; loan must mature for at least 5 years before insurance can be used