Farm Financial Statement
Farm Financial Statement
Farm Financial Statement
Co-Applicant:
Social Security Number
Street Address:
Co App:
ASSETS
LIABILITIES
Current Assets
Cash, Checking, Savings
Sch. 1
Sch. 2
Sch. 3A
(attach
broker's statement)
Current Liabilities
Accounts Payable
Sch. 10
Crop Inventory
Feed Inventory
Market Livestock Inventory
Sch. 4
Sch. 5
Sch. 5
Sch. 6
Sch. 7
Sch. 7
Other
Accrued interest
Supplies
Coop Retains Receivable
Other Current Assets
Sch. 7
Sch. 4
Sch. 11
Sch. 5
Sch. 2
Intermediate Debt
(balance less current portion)
Sch. 8
Sch. 9
Sch. 12
Sch. 13
Sch. 9
TOTAL LIABILITIES
OWNER'S EQUITY
TOTAL LIABILITIES & EQUITY
TOTAL ASSETS
RATIOS
Current Ratio
Debt/Equity Ratio
Working Capital
The foregoing Balance Sheet including the attached schedules 1 through 14 is submitted for the purpose of obtaining new credit or continue existing credit of the undersigned or to
support credit for others based on the guaranty of the undersigned. The undersigned acknowledges and understands that First Bank of Berne (Lender) is relying on the information
provided in this Balance Sheet to make a decision on such requested credit. Undersigned gives Lender authorization to retain Balance Sheet and supporting schedules, whether or
not Lender approves loan request.
Each of the undersigned represents, warrants, and certifies that the information provided herein is true, correct, and complete. In addition, the undersigned will promptly notify
Lender of any subsequent substantial changes in financial condition.
Each of the undersigned agree that even though this Balance Sheet may support a proposed or existing business purpose loan(s), the Lender is authorized to order a consumer
credit report to verify loan information contained herein for as long as the proposed or existing loan(s) remain payable to Lender.
Date Signed
Date Signed
Page 1 of 17
Account #
Amount
1 Checking
2
3
4 Savings
5
6 Cash on Hand
TOTAL
Person Insured
Beneficiary
Face Amount
Cash Value
Amount Borrowed
(if any)
1
2
3
TOTALS
Owners Name(s)
If Pledged, to
Whom
No of
Stock Exchange Shares
Price per
Share
Value
1
2
3
4
TOTAL $
TOTAL $
SCHEDULE 3B: NON-MARKETABLE SECURITIES INCLUDING RETIREMENT ACCTS- IRA's, 401 K, ETC
1
2
3
4
Amount Due
Beyond 12 mos.
TOTALS
TOTALS
Feed Inventory
Page 2 of 17
TOTALS
Page 3 of 17
Description
Avg $ per
Current
Weight cwt Dollar Value
TOTALS
Breeding Livestock
Description
Number of
Head
Dollars per
Head
Current
Dollar Value
Number of
Head
Dollars per
Head
Current
Dollar Value
TOTALS
Miscellaneous Livestock
Description
TOTALS
TOTAL
TOTAL
Supplies
Dollar
Amount
Description
Dollar
Amount
TOTAL
Page 4 of 17
Make
Model
Description
SUBTOTAL
Market
Value
Year
Make
Model
Description
Market Value
SUBTOTAL
TOTAL
Page 5 of 17
Description
Titled in Names of
Yr.
Acquired
Cost
Basis
Total
Acres
Crop
Acres
Market
$/Acre
Valuation
Est. Market
Est. Market Value
Value of Land
of Improvements
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
TOTALS
Date Last
Payment Made
Maturity
Date
Payment
Freq.
Loan
Balance
Interest
Rate
Annual
Pymnt
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Principal
Payment
Accrued
Interest
-
Princ Due
Beyond 12
m
TOTALS
Due Date
Amount Due
TOTAL
Page 6 of 17
Maturity
Date
Collateral Description
Interest
Rate Loan Balance
Accrued
Interest
1
2
3
4
TOTAL
Payment
Freq.
Loan
Balance
Interest
Rate
Annual
Pymnt
Principal
Payment
Accrued
Interest
-
Princ Due
Beyond 12
m
TOTALS
Amount Due
within 12 mos
Amount Due
beyond 12 mos
TOTALS
Line of Business
Years in
business Ownership %
Business Net
Worth
Your Present
Value
-
TOTALS
Page 7 of 17
Page 8 of 17
Your DOB
Spouse DOB
Ages of dependents
Actual
Yield
Bu
for feed
Actual/
X Expected
Price
Gross
Income
Corn
$0.00
$0
Soybeans
$0.00
$0
Wheat
$0.00
$0
Hay
$0.00
$0
Other
$0.00
$0
$0.00
$0
TOTAL $0
X Expected
Yield
Minus Bu
for feed
X Expected
Price
Gross
Income
Corn
$0.00
$0
Soybeans
$0.00
$0
Wheat
$0.00
$0
Hay
$0.00
$0
Other
Ex. Silage, Oats, etc
$0.00
$0
TOTAL $0
Crop Insurance
Corn
Soybeans
Wheat
Hay
Other
50-90%
0%
0%
0%
0%
0%
0
0
0
0
0
Landlord
Type of Lease
Expires
Soybeans
Seed
Fertilizer
Chemicals
Dryer Fuel
Machinery Fuel
Machinery Repair
Hauling
Interest
Insurance
Machinery Replacement
Drying & Handling Replacement
Family & Hired Labor
Land Cost
Farm Insurance
Utilities
Custom Hire
Consultants
Hired Labor
Marketing
Land Rent
Machinery Leases
Accounts Payable
Building Leases
Feed Purchases
Livestock Leases
Grazing Fees
Wheat
Acres
Est. Yield
Price/Bu.
TOTAL
$
$
1
198
3.80
752
$
$
1
60
8.40
504
Est. Yield
Price/Bu.
TOTAL
$
$
1
85
4.80
408
TOTAL INCOME
1,664
SoybeanAcres
Est. Yield
Price/Bu.
TOTAL
Wheat Acres
EXPENSES
Corn
$
$
$
$
$
$
$
$
$
$
$
$
$
158
123
42
46
15
22
19
13
32
98
5
46
269
TOTAL EXPENSES
888
NET INCOME
Fertilizer
Seed
Pesticides
Dryer Fuel
Machinery Fuel
Machinery Repair
Hauling
Interest
Insurance & Misc.
Machinery Replacement
Drying & Handling Replace
Family & Hired Labor
Land Cost
Soybeans
$
63
$
74
$
27
$
$
9
$
18
$
6
$
7
$
23
$
98
$
5
$
46
$
269
Wheat
$
$
$
$
$
$
$
$
$
$
$
$
$
98
44
12
9
18
9
6
3
98
5
46
269
645 $
617
(136) $
(141) $
(209)
(486)
158
123
42
46
15
22
19
13
32
98
5
46
269
63
74
27
98
44
12
9
18
6
7
23
98
5
46
269
9
18
9
6
3
98
5
46
269
Estimated Date
Personal Assets
Amount ($)
Inheritances, Gifts Received
Captial Distributions, dividends, gifts given
Income and Social Security Tax
Family Living Expense
Nonfarm Income
CROP YEAR
JAN
FEB
APR
MAY
JUN
JUL
SEP
OCT
MAR
-
AUG
-
NOV
-
DEC
-
INCOME ITEMS
EXPENDITURES
16. Labor Hired - Including taxes
17. Fertilizer & Lime
18. Chemicals
19. Seed
20. Custom Hire
21. Supplies
22. Rent - Land
23. Rent & Leases - Machinery & Bldgs.
24. Gas, Oil & Fuel
25. Storage & Custom Drying
26. Feed Purchases
27. Veterinary, Medicine, Breeding Fees
28. Feeder Livestock Purchases
29. Utilities
30. Repairs - Equipment & Buildings
31. Insurance
32. Taxes - Real Estate & Personal Prop.
33. Capital Expenditures - Equip, Bldgs
34. Capital Expenditures - Breeding Stock
35. Hedging Account Deposits
36. Family Living Withdrawals
37. Other
38. Other
39. Total Cash Required (Add Lines 16-38) 40. Cash Position (Line 15 - Line 39)
41. Intermediate & Mortgage New Loans
42. Term & Mtg Loan Principal Payments
43. Term & Mtg Loan Interest Payments
44. Operating Loan Interest
45. Cash Position (40+41-42-43-44)
46. Operating Loan - Draw
47. Operating Loan - Payment
48. Ending Cash Position (45+46-47)
49. Operating Loan Balance
I hereby authorize the Lender to verify my past and present employment earnings, records, bank
accounts, stock holdings and any other asset balances that are needed to process my loan
application.
I further authorize the Lender to order a consumer credit report and verify other credit information,
including past and present mortgage and landlord references.
The information the Lender obtains is only to be used in the processing of my application for a loan.
If I am requesting a loan from Lender to payoff an existing debt with another financial institution, I
hereby authorize Lender to obtain a payoff figure on the existing loan.
Signature:
Date:
Signature:
Date: