Current Assets and Liabilities

Current Assets and Liabilities Checking & Savings Balances Type Account Marketable Securities and/or Hedging Account Deposited With Balance Descri...
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Current Assets and Liabilities Checking & Savings Balances Type Account

Marketable Securities and/or Hedging Account

Deposited With

Balance

Description

# Shares

TOTAL:

Secured?

Harvested Crops stored available for sale Amount Due

Crop

Unit

Quantity

TOTAL:

Acres

Cost/Acre

Description

# Head

Avg. Wt.

Value Per Hd.

Total Value

TOTAL:

Due Date

Amount

Refi?

Accounts Payable

Inventory Supplies on hand and/or Prepaid Expenses Description

TOTAL:

Quantity

Price

Amount

TOTAL:

Total Amount of Line

Refi?

Operating Line of Credit Notes Payable Creditor

Value

Livestock held for Sale (NOT breeding stock)

Investment

TOTAL:

Description

$ per Unit

TOTAL:

Cash Invested in Growing Crops Crop

Value

TOTAL:

Accounts Receivable Due From

Value per Share

Current Principal Amount Outstanding

TOTALS: Form & Spreadsheet Template Copyright © 2002 Associated Farm Mortgage, Inc.

FS Printed: 9/15/2003

Interest Rate Accrued % Interest Due

Maturity Date

Equipment Listing Condition

Description

Year Model

Market Value

Totals from additional schedules:

Pledged to

Detailed item listing is required TOTAL:

Equipment & Chattel Debt

Number

Interest

$ Principal

$ Accrued

Creditor

Pmts Yr.

Rate %

Balance owning

Interest due

Payment $

Maturity

Refinance?

Totals:

Printed: 9/15/2003

FS

FS Page B

Coll?

Real Estate Schedule Property Description

Crop Acres

Year Acquired

Number of

Interest

Principal

Accrued

Pmts Year

Rate %

Balance

Interest Due

Type Property Total Acres

Current Fair Market Value

Tract Status

Creditor

Maturity

Refinance?

Owned Real Estate Totals:

Real Estate Debt Schedule Creditor

Payment $

Totals:

Breeding Livestock Schedule Description

Value per Head

Average Weight

Other Farm Assets

Number of Head

Total Market Value

Number of

Interest

Principal

Accrued

Pmts Year

Rate %

Balance

Interest Due

Purchase

Remaining Years on Lease

Description

Totals:

Breeding Livestock Debt Creditor

Payment $

Value

Total: Maturity

Refinance?

Totals:

Capital Lease Assets Refi

Total Lease

Description

In Years

Annual Lease Payment

Option in $

Lease Company

Total:

Other Farm Term Debt Creditor

Payment $

Number of

Interest

Principal

Accrued

Pmts Year

Rate %

Balance

Interest Due

Maturity

Refinance?

Crop Acres

Written or Verbal

Annual Cost

Month Due

Landlord

Totals: Rented &/or Leased Property Information: Property Description

Type Contract Total Acres

TOTALS:

Other Assets Schedule Notes & Contracts Receivable Due From

Date last pmt.

Principal Balance

Interest Rate

Total Annual Payment Amt

Farm Investment in Cooperatives Description

Totals:

Value

Total:

Farm Assets not described elsewhere Item

Type

Off-Farm Employment Data # units

Value Each

Total Value

Employer

Totals:

Personal Assets & Information

Wage Earner

Annual Earnings

Total: Value

Contact Information:

Face Value of Life Insurance

Address:

Cash Value of Life Insurance

City, ST Zip:

Retirement Accounts & Investments

Home Phone:

Household goods & personal effects

Fax:

Collectables

Cell:

Equity in Non-Marketable closely held companies

Work Phone:

Total:

Consumer & Credit Card Debt Schedule Creditor

Monthly Payment

Totals:

Interest

Principal

Rate

Balance

Current or Security

Past Due?

Refinance

AGRICULTURAL FINANCIAL STATEMENT Statement of: Submitted to: Associated Farm Mortgage, Inc.

Date of Statement:

ASSETS CURRENT ASSETS

LIABILITIES & EQUITY AMOUNT

CURRENT LIABILITIES

Cash, Checking, Savings & Equivalent

Accounts Payable

Marketable Securities

Line(s) of Credit outstanding

Accounts Receivable

Accrued Interest due

AMOUNT

Harvested Crops for Sale Livestock held for Sale Investment in Growing Crops Supplies &/or Prepaid Expense

TOTAL CURRENT LIABILITIES:

TERM LIABILITIES Equipment Debt

Current portion of Notes Receivable Cash Value Life Insurance

Breeding Livestock Debt

TOTAL CURRENT ASSETS:

TERM ASSETS

Other Farm Debt

Equipment, Machinery, Vehicles Breeding Livestock

Capital Leases outstanding

Capital Lease Assets Book Value Notes Receivable Long Term Portion

Real Estate Mortgages

Farm Investments Other Farm Assets

Consumer Debt

Real Estate Misc. Assets

NET TERM LIABILITIES:

Personal Assets

TOTAL LIABILITIES TOTAL TERM ASSETS:

TOTAL ASSETS

Net Worth (assets - liabilities) TOTAL LIABILITIES & EQUITY

Form & Spreadsheet Template Copyright © 2002 Associated Farm Mortgage, Inc.

CERTIFICATION: I/We hereby certify that this financial statement is true and correct to the best of my/our knowledge and belief. This statement including all related schedules were consented to and reviewed by me/us or made directly by me/us for the purpose of procuring and/or maintaining commercial credit. I/We understand the recipient of this statement is relying on the accuracy and truthfulness of this statement in conjunction with our requested financial accommodation. The holder of this statement may rely on it as being true and correct until I/We otherwise notify the holder in writing. If this is a joint financial statement, these representations and warranties are from each of us. If this is a statement of an entity, the representations and warranties are those of that entity, and certified by the undersigned as an authorized agent of that entity.

Date: Signature

Date:

Please provide a complete listing of ALL creditors along with the contact information requested below but only IF this information was NOT supplied on your current Financial Statement. If you utilized AFM's Financial Statement template (Excel or PDF), then a creditor contact information form is with that template.

For Credit Cards and other consumer debt that bills monthly, please provide a copy of last months statement, in lieu of listing below. Creditor

Account Number

Address

City, State ZIP

Phone Number

Fax Number