BALANCE SHEET FOR: _________________________________________ (date) As of: Address:__________________________________________
Assets
Liabilities
Current Farm Assets
Current Farm Liabilities
Phone:_____________
Cash in checking and savings
$
Bank loans/lines of credit
Crops on Hand (Sch. B page 3)
$
Loan Number Due Date
Int. Rate
Market Livestock (Sch C, page 3)
$
Pre-paid Expenses (Sch. D, page 3)
$
Growing Crops (Sch. E, page 3)
$
Accounts Receivable (Sch H, page 3)
$
CCC Loans:
Int. Rate
Other Current Farm Assets:
$
Bushels
Due Date
$
Total Current Farm Assets
$
Business Credit Cards (Sch.J, page 4)
$
Accounts Payable (Sch. I, page 4) Accrued Interest on Operating & CCC Loans
Current Non-farm Assets
Term Payments due within 12 months (Sch.K,page 4)
Savings and certificates of deposit
$
Accrued Interest on Term Loans (Sch, K page 4)
Stocks and securities (Sch F, Page 3)
$
Other Current Farm Liabilities
Accounts Receivable (Sch H, page 3) Other Non-farm Current Assets
$ $ $
Total Current Farm Liabilities
$
Total Current Non-farm Assets
$
Current Non-farm Liablities Non-farm credit cards (Sch. J. page 4)
Total Current Assets
$
Non-farm accounts payable (Sch. I,page 4) Non-farm term debt due in 12 months (Sch. L., page 4)
Non-Current Assets
Accrued Income and RE taxes
Farm Assets Machinery and Equipment (Sch.N, page 5)
$
Total Current Non-farm Liabilites
Breeding Livestock (Sch. M., page 4)
$
Total Current Liabilities
Farm Real Estate (Sch.O, page 6)
$
Other:
$
Non-Current Liabities
$
Farm Liabilities
$
Term loans due beyond 12 mos. (Sch K, page 4)
$
Other:
Cash value life insurance (Sch A, Page 2)
$
Total Farm non-current Liabilies
Value of Retirement Plans (Sch. G, Page 3)
$
Non-farm Liabilities
Personal vehicles
$
Life insurance loans (Sch. A, page 2)
Non-Farm Real Estate
$
Term and mortgages (Sch. L,page 4)
Other:
$
Other:
$
Total Non-farm, non-current Liabilites
$
Total Non-current Liabilities Total Farm Liabilities Total Non-Farm Liabilities Total Liabilities Net Worth Total Liabilities & Net Worth
Total Farm Non-Current Assets
Non-farm Assets
Total Non-farm, Non-current Assets
$
Total Non-current Assets Total Farm Assets Total Non-farm Assets Total Assets
$ $ $ $
Page 2 (Married, Separated, Unmarried) Your date of Birth: Marital Status:_____ Age of Dependents: If you have off-farm employment, please furnish the following information: Employer's Nam _______________________________________ Year on Job: Address and work phone number: Annual Take-Home Pay: Have you filed all necessary federal and state labor and income tax returns? Are any taxes delinquent or under dispute? Are you the defendant in any lawsuits? Do you have any judgements or mechanic's liens outstanding? Are you now or have you ever been bankrupt? Do you have a will? ____________ _______________ How much liability insurance do you have? How much insurance do you have on the machinery? __________ Do you carry crop insurance and if so, how much per acre? Hail Amount Multi-PeAmount Corn Yes/No $ Yes/No $ Beans Yes/No $ Yes/No $ Wheat Yes/No $ Yes/No $ Policy Number Agent's Name Phone # Insurance Company ____________________ ________________ ________________ Machinery ________________ Hail Insurance ____________________ ________________ ________________ Multi-peril Insura____________________ ________________ Do you have health insurance? Yes/ No Do you have life insurance? If so, please provide the following information: Schedule A. Face Type of Surrender Policy Value Policy Value Name of Insurance Company Loan $ $ $ $ $ $ $ $ $ $ Total Loans: $ Total Cash Value$
The information contained on this page and all attached sheets is for the purpose of obtaining and/or maintaining credit with the First National Bank of Manhattan. The undersigned certifies the information contained herein to be complete and correct. The undersigned authorizes the First National Bank of Manhattan to make all inquiries deemed necessary to verity the accuracy of the information contained herein. The First National Bank of Manhattan is authorized to answer questions about the Bank's credit experience with me (us).
Signature:
SS #: Date
Co-Applicant:
SS #: Date
Page 3 Schedule B:Crops on Hand
Schedule C: Market Livesock
Grain already priced:
Descriptio Number
Crop
Bushels
Weight
Price/cwt
Value
Price
Gross Val Steers
$
$
Corn
$
$
Steers
$
$
Corn
$
$
Heifers
$
$
Beans
$
$
Heifers
$
$
Beans
$
$
Cull Cows
$
$
Other
$
$
Fat Hogs
$
$
$
$
Fat Hogs
$
$
$
$
Feeder Pigs
$
$
Cull Sows
$
$
$
$
Grain not priced Crop
Bushels
Price
ross Value Other
Corn
$
$
$
$
Corn
$
$
$
$
Beans
$
$
Beans
$
$
Other
$
$
Total Schedule D: Pre-paid Expenses
$
$
Product
$
Total
$
$
Fertilizer
$
Herbicides
$
Inputs or Acres
Value/Acre
Insecticides
$
Nitrogen
$
Seed
$
Value Fuel
$
$
$
$
$
$
$
$
$
$
Total
Cost
$
Schedule E: Growing Crops Crop
$ $
Other
$
$ $
$
Total
$
Schedule F: Stocks and SecuritSchedule G: Retirement Plans (Marketable) Shares
Name
Value Type
Name
Value
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
Schedule H: Accounts Receivable Due from
Farm A/R
Non-farm A/R
$
$
$
$
$
$
$
$
$
$
PAGE 4 Schedule I. Accounts Payable Non-farm Accounts Payable
Farm Accounts Payable Repairs
$
Fertilizer $
$
Rent
$
Fuel
$
$
Seed
$
OTHER
$
$
$
Chemicals$ $
TOTAL
$
$
Total
$
Schedule J. Credit Cards Farm Expenses Card
Non-Farm Expenses Amount
Card
Amount
$
$
$
$
$
$
$ Total
$
$
Total
SCHEDULE K:TERM DEBTS AND MORGAGES FOR THE FARM Lender
Purpose
Principal Payments
Payment Payment
Accrued
Principal
Pricipal due
Date
Amount
Interest
Balance
next 12 mos. beyond 1 yr
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
Totals
SCHEDULE L: NON-FARM TERM DEBTS AND MORTGAGES Lender
Purpose
$
Principal due
Principal Payments
Payment Payment
Accrued
Principal
Pricipal due
Date
Amount
Interest
Balance
next 12 mos. beyond 1 yr
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
NUMBER
WEIGHT
VALUE/UNIT VALUE
Totals
Principal due
SCHEDULE M: BREEDING LIVESTOCK DESCRIPTION
$
$
$
$
$
$
$
$
$
$
$
$ $
PAGE 5 SCHEDULE N: Machinery and Equipment (Incldue farm pickup truck)
Description
Make
Model Number
______________________________________________________
Year
Value
__________
______________
__________________________________________
__________
______________
______________________________________________________
__________
______________
______________________________________________________
__________
______________
______________________________________________________
__________
______________
______________________________________________________
__________
______________
______________________________________________________
__________
______________
______________________________________________________
__________
______________
______________________________________________________
__________
______________
______________________________________________________
__________
______________
______________________________________________________
__________
______________
______________________________________________________
__________
______________
______________________________________________________
__________
______________
______________________________________________________
__________
______________
______________________________________________________
__________
______________
______________________________________________________
__________
______________
______________________________________________________
__________
______________
______________________________________________________
__________
______________
______________________________________________________
__________
______________
______________________________________________________
__________
______________
______________________________________________________
__________
______________
______________________________________________________
__________
______________
______________________________________________________
__________
______________
______________________________________________________
__________
______________
______________________________________________________
__________
______________
______________________________________________________
__________
______________
______________________________________________________
__________
______________
______________________________________________________
__________
______________
______________________________________________________
__________
______________
______________________________________________________
__________
______________
______________________________________________________
__________
______________
______________________________________________________
__________
______________
______________________________________________________
__________
______________
______________________________________________________
__________
______________
______________________________________________________
__________
______________
______________________________________________________
__________
______________
______________________________________________________
__________
______________
______________________________________________________
__________
______________
______________________________________________________
__________
______________
______________________________________________________
__________
______________
______________________________________________________
__________
______________
______________________________________________________
__________
______________
______________________________________________________
__________
______________
______________________________________________________
__________
______________
______________________________________________________
__________
____________________
Total
Page 6 Schedule O: Land Owned Parcel I
Value
Acres
Brief Legal Description
Per Acre
________
_____________________________________
Fair Market Value ____________________
______________________________ ______________________________ Parcel II
________
_____________________________________
____________________
______________________________ ______________________________ ______________________________ Parcel III ________
_____________________________________
____________________
______________________________ ______________________________ ______________________________ Total Land Rented
$
Type of
Landlord Acres
Brief Legal Description
Lease
________
____
_____________________________________
Annual Cash Rent ________________
________
____
_____________________________________
________________
________
____
_____________________________________
________________
________
____
_____________________________________
________________
________
____
_____________________________________
________________
________
____
_____________________________________
________________
________
____
_____________________________________
________________
________
____
_____________________________________
________________
________
____
_____________________________________
________________
________
____
_____________________________________
________________
________
____
_____________________________________
________________
________
____
_____________________________________
________________
________
____
_____________________________________
________________
________
____
_____________________________________
________________
________
____
_____________________________________
________________
________
____
_____________________________________
________________
________
____
_____________________________________
________________
________
____
_____________________________________
________________
________
____
_____________________________________
________________
________
____
_____________________________________
________________
________
____
_____________________________________
________________
________
____
_____________________________________
________________
Page 7
If you have grain or livestock in inventory, please explain your marketing plan. Some of the inventory may be priced or hedged. If that is so please indicate it Crop
Bushels Date
Livestock Number Date Type
Price/BUGross InNotes
Price/CWTGross
InNotes
Planned Capital Purchases Planning for Capital Purchases is an essential part of any farming operation. Planning the financing for such purchases is as important as choosing the particular machine to add to your farm. Type of MachineTime Period
Cash BoWhat will be traded? Borrowed?
Budget for next year Name:
Year:2013
Planned crops, production and sales Operator's Sales Yield/ Operator's Less: Acres Acre Share Farm Use Crops: ________ ________ Corn - crop-share ______________ Corn - full share ______________ ________ ________ Beans- crop-share ______________ ________ ________ Beans - full share ______________ ________ ________ Other Crops: ______________ ________ ________ Wheat ______________ ________ ________ ______________ ________ ________ ______________ ________ ________ Total
Livestock Fat Cattle Finished hogs Cull cows Cull sows Cash O Expenses
Production Per Animal ________ ________ ________ ________
Operator's NumberShare ______ ________ ______ ________ ______ ________ ______ ________
Planned Expenses
Hired Labor Repairs Cash Rent Seed Fertilizer Chemicals Machinery Hire Fuel and Oil Real Estate Taxes Storage & Drying Property Insurance Auto & Truck Costs Utilities Feed Livestock Expenses Feeder Livestock Misc. Family Living Interest TOTAL
Less: Farm Use ________ ________ ________ ________ CREDIT NEEDED ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________
TOTAL
Amount ________ ________ ________ ________ ________ ________ ________ ________ Total
Price
Gross Sales
$5.30 $5.30 $12.00 $12.00 $0.00 $6.50
Gross Amount Price Sales ________ $120.00 ________ $68.00 ________ $70.00 ________ $45.00
Page 2
Livestock Income Crop Income Other Farm Income Off-Farm Income Total Gross Income Cash Expenses Net Cash Income Operating Loan Interest Available for Debt Servicing
Debt Servicing
Income & SS Taxes TOTAL Term Debt Service Coverage
ADDITIONAL INFORMATION
$
Principal and Interest ________ ________ ________ ________ ________ ________ ________ ________
Interest Only ________ ________ ________ ________ ________ ________ ________ ________
Due Date ________ ________ ________ ________ ________ ________ ________ ________
Source of Repayment ________ ________ ________ ________ ________ ________ ________ ________
__
$ $ $
$ $ $ $ $ $ $ $ $ $ $
$ $ $ $ $ $ $
$ $ $ $ $
$ $ $ $ $ $ $ $ $ $
