Submit the original of the
completed form in hard copy or facsimile to the appropriate USDA servicing
office.
Producers
who have established electronic access credentials with USDA may electronically
transmit this form to the USDA servicing office, provided that the producer
submitting the form is the only person required to sign the transaction.
Features
for transmitting the form electronically are available to those producers with
access credentials only.� If you would
like to establish online access credentials with USDA, follow the instructions
provided at the USDA eForms web site.
|
Fld Name / |
Instruction |
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|
1 Name |
Enter
the applicant�s name. |
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|
2 Date
of Balance Sheet |
Enter
the date of the balance sheet. |
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A - Current Assets (1A � 1U) |
|
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|
1A Cash
and Equivalents |
Enter
cash on hand, checking, savings, and the dollar value of each.� For an entity, enter the amount of cash in
the farm business account. |
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|
1B Marketable
Bonds and Securities |
Enter
other investments and the dollar value of each. Note: Enter certificates of
deposit, treasury bills, or any other cash accounts maturing in less than 12
months. Enter any other cash such as hedging account equity or marketable
bonds and securities.� Do not include
IRA or other retirement accounts. |
|||
Fld Name / |
Instruction |
1C Accounts
Receivable |
Enter
all accounts and notes with dollar value that are owed to the producer from
business sales or services with a due date of 12 months or less. |
1D Crop
Inventory |
Enter
the types of crops and commercial feed held in inventory on the farm or in a
commercial storage facility. Enter any crops in the Commodity Credit
Corporation (CCC) program with a due date of less than one year.� An entry will be made later under current
liabilities. |
1E Measure |
Enter the unit produced ( i.e., weight, bushels, numbers,
etc.)
|
1F #
Units |
Enter
the number of units held in inventory for each crop. |
1G $/Unit |
Enter
the price per unit for each crop as of the balance sheet date.� Use local market prices or forward contract
prices after adjusting for marketing expenses.� The loan rate provides a price floor for
grain in the CCC loan program.�
Therefore, use the higher of either the loan rate or current market
price. |
$
Value Column |
Enter
the total value of each crop.� (Item 1F
x Item 1G) |
1H Growing
Crops |
Enter
the types of growing crops. |
1I.
#
Acres |
Enter
the number of acres growing for each crop. |
1J Cost/Acre |
Enter
the estimated input cost per acre for each crop growing.� Include costs for seed, fertilizer, fuel,
etc.� If actual production expenses are
not known, standard budget expenses can be used. |
$
Value Column |
Enter
the total investment for each crop. (Item 1I x Item 1J) |
1K Market
Live-stock Poultry |
Enter
the type(s) of livestock held that will be sold within 12 months. |
1L #
Head |
Enter
the number of each type of livestock. |
1M Weight |
Enter
the average weights for each type of livestock.� |
1N $/Unit |
Enter
the market price per unit as of the balance sheet date.� Use local market prices or forward contract
prices after adjusting for marketing expenses. |
$
Value Column |
Enter
the total value of each type of livestock.�
(Items 1L x 1M x 1N) |
1O Livestock
Products |
Enter the type of livestock product held that will be sold
within 12 months.
|
1P Measure |
Enter the unit the product is sold as, such as
weight or numbers (number of culls, pounds of wool). |
1Q #
Units |
Enter the number of units held in inventory for
each type of livestock product. |
1R $/Unit |
Enter
the price per unit for each product as of the balance sheet date. |
$
Value Column |
Enter
the total value for each type of livestock product. (Item
1Q x Item 1R) |
1S Prepaid
Expenses and Supplies |
Enter
the total value of supplies on hand, prepaid expenses and other inventoried
assets.� The value used for
fertilizers, seeds, chemicals, fuel and oil should be the cost value.� |
1T
Other
Current Assets |
Enter
the description and value of any other current assets which have not been
accounted. |
1U Total
Current Assets |
Enter
the total of all current farm assets. (Item 1A through Item 1T) |
B - Current Liabilities (2A � 2N) |
|
2A Accounts
Payable |
Enter
the name of the lender, dealer, bank, or individual to whom the accounts are
owed. |
$
Amount Column |
Enter
the payment amount due for each account
as of the balance sheet date. |
2B Income
Taxes Payable |
Enter
a description of taxes owed, such as State, Federal income and Social
Security taxes. |
$
Amount Column |
Enter the payment amount due for all taxes
due, including amounts owed for employees, as of the balance sheet date. |
2C Real
Estate Taxes Payable |
Enter
a description of taxes that have accrued on real estate and personal property
as of the date of the balance sheet.�
Include any other levied assessments or taxes that have accrued. |
$
Amount Column |
Enter the payment amount due for all
accounts as of the balance sheet date. |
2D(1-4) Creditor |
Enter the name of each creditor for notes
payable due within 12 months. |
2E(1-4) Purpose |
Enter
the purpose for each note in Item 2D (Item 1 through Item 4). |
2F(1-4) Interest
Rate |
Enter
the interest rate for each note listed in Item 2D (Item 1 through Item 4). |
2G(1-4) Accrued
Interest |
Enter
the accrued interest for each note listed in Item 2D (Item 1 through Item 4)
as of the balance sheet date. |
2H(1-4) Payment
Amount |
Enter
the monthly or quarterly payment amount due, for each note listed in Item 2D
(Item 1 through Item 4). |
2I(1-4) Next
Payment Date |
Enter
the next payment due date. |
2J(1-4) Principal
Balance |
Enter
the unpaid principal balance for each note listed in Item 2D (Item 1 through
Item 4) as of the balance sheet date. |
2K(1-3) Accrued
Interest and $ Amount Column |
Enter
the amount of accrued interest for (Item 1) Current Liabilities, (Item 2)
Intermediate Liabilities, and (Item 3) Long Term Liabilities as of the
balance sheet date. |
2L(1-2) Current
Portion of Principal and $ Amount Column |
Enter
the current portion of principal due on (Item 1) Intermediate Liabilities,
and (Item 2) Long Term Liabilities. |
2M Other
Current Liabilities |
Enter
the creditor�s name for any other liability due within the next 12 months. |
$
Amount Column |
Enter
the dollar amount due as of the balance sheet date. |
2N Total
Current Liabilities |
Enter
the total of all $ Amounts and Principal Balances. |
C -� Intermediate Assets (3A �
3I) |
|
3A
Dollar
Value Column |
Enter
the dollar value of Machinery and Equipment (Item 11H) and Farm Vehicles
(Item 12H) totaled. |
3B Breeding
Stock |
Enter
all types of breeding livestock owned. |
3C Raised/Purch |
Enter
(R) for raised or (P) for purchased for each animal. |
3D #
Head |
Enter
the number of each type of breeding livestock. |
3E $/Head |
Enter
the current market price per animal for each type of livestock as of the
balance sheet date. |
$
Value Column |
Enter
the dollar value for each type of breeding livestock. (Item 3D x Item 3E) |
3F Notes
Receivable |
Enter
notes that will not be received in the current year, but will be received
within 10 years. |
3G Not
Readily Marketable Bonds & Securities |
Enter
other investments and the dollar value of each. Note: Enter certificates of
deposit, treasury bills, or any other cash accounts maturing in more than 12
months. Include any other cash, such as hedging account equity or marketable
bonds and securities.� Do not include
IRA or other retirement accounts. |
3H Other
Inter-mediate Assets |
Enter
co-op stock, life insurance cash value, etc. |
3I Total
Intermediate Assets |
Enter
the total of all intermediate farm assets from Item 3A through Item 3H in the
$ Value column. |
D - Long Term Assets |
|
4A Building
& Improvements |
List
all buildings and improvements owned and $ Value for each. |
4B Real
Estate-Land |
Enter
all of real estate-land owned.� Provide
brief description. |
4C Total
Acres |
Enter
total acres for land listed in Item 4B. |
4D Crop
Acres |
Enter
total crop acres for land listed in Item 4B. |
4E %
Owned |
Enter
percent of ownership you hold for land listed in Item 4B. |
4F $/ |
Enter
dollar value per acre for land in Item 4C.
|
$
Value Column |
Enter
value of land. (Items 4C x 4E x 4F).
|
4G Other
Long Term Assets |
Enter
the current market value of any other type of long term farm asset not
listed.� Include accounts and notes
with a maturity of over 10 years. |
$
Value Column |
Enter
the dollar value for other long term assets as of the balance sheet date. |
4H Total
Long Term Assets |
Enter
the total of all long term assets from Item 4A through 4G in the $ Value
column. |
4I Total
Farm Assets |
Enter
the total value of all farm assets entered.�
(Total of Current Assets (Item 1U), Intermediate Assets (Item 3I) and
Long Term Assets (Item
4H)). |
E - Intermediate Liabilities (5A � 5H) |
|
5A(1-7) Creditor |
Enter
each creditor�s name for intermediate liabilities. |
5B(1-7) Purpose |
Enter
the purpose for each debt listed in Item 5A. |
5C(1-7) Interest
Rate |
Enter
the interest rate for each debt listed in Item 5A. |
5D(1-7) Accrued
Interest |
Enter
the accrued interest for each debt listed in Item 5A as of the balance sheet
date. |
5E(1-7) Payment
Amount |
Enter
the payment amount due for each debt listed in Item 5A. |
5F(1-7) Next
Payment Date |
Enter
the next payment due date. |
5G(1-7) Principal
Balance |
Enter
the unpaid principal balance for each debt listed in Item 5A as of the balance
sheet date. |
5H Total
Intermediate Liabilities |
Enter
the total of all $Amounts from Item 5G (Item 1 through Item 7). |
F- Long Term Liabilities (6A � 6J) |
|
6A(1-7) Creditor |
Enter
each creditor�s name for long term liabilities. |
6B(1-7) Purpose |
Enter
the purpose for each long term debt listed in Item 6A. |
6C(1-7) Interest Rate |
Enter
the interest rate for each long term debt listed in Item 6A. |
6D(1-7) Accrued Interest |
Enter
the accrued interest for each long term debt listed in Item 6A
as of the balance sheet date. |
6E(1-7) Payment
Amount |
Enter
the payment amount due for each long term debt listed in Item
6A. |
6F(1-7) Next
Payment Due |
Enter
the next payment due date. |
6G(1-7) Principal
Balance |
Enter
the unpaid principal balance for each long term debt listed in Items 6A. |
6H Total
Long Term Liabilities |
Enter the total long term liabilities listed in Item 6G as of
the balance sheet date. |
6I Total
Farm Liabilities |
Enter the total farm liabilities. (Item 2N + Item 5H + Item 6H). |
6J Total
Farm Equity |
Enter the total farm equity. (Item 4I minus Item 6I). |
G -
Personal Assets (7A � 7M) |
|
7A Cash
and Equivalents |
Enter the value of personal cash and equivalents. |
7B Stocks
and Bonds |
Enter the value of personal stocks and bonds. |
7C Cash
Value Life Insurance |
Enter the cash value of
life insurance policies. Do not duplicate amounts included in Item 3H. |
7D Other
Current Assets |
Enter the value of any
other personal current assets. |
7E Household
Goods |
Enter the value of all
household goods. |
7F Car,
Recreational Vehicle, etc. |
Enter the value of all
personal, recreational, or non-farm vehicles. |
7G Other
Inter-mediate Assets |
Enter the value of any
other personal intermediate assets. |
7H Retirement
Accounts |
Enter the value of
retirement accounts. |
7I Non-Farm
Business |
Enter the value of all non-farm businesses. |
7J Non-Farm
Real Estate |
Enter
value of non-farm real estate. |
7K Other Long Term Assets |
Enter
the value of any other long term assets. |
7L Total
Personal Assets |
Enter
the total dollar value of all personal assets. (Item 7A through Item 7K) |
7M Total
Assets |
Enter
the total dollar value of all assets.�
Total Farm Assets (Item 4I) and Total Personal Assets (Item 7L). |
H - Personal
Liabilities (8A � 8K) |
|
8A(1-4) Creditor |
Enter each creditor�s name for personal debts. |
8B(1-4) Purpose |
Enter the purpose for each personal debt. |
8C(1-4) Interest
Rate |
Enter the interest rate of each personal debt. |
8D(1-4) Accrued
Interest |
Enter the accrued interest for each personal debt as of the
date of the balance sheet. |
8E(1-4) Payment
Amount |
Enter the payment amount due for each personal debt. |
8F(1-4) Next
Payment Date |
Enter the next payment due date. |
8G(1-4) Principal
Balance |
Enter the unpaid principal balance for each
personal debt as of the date of the balance sheet. |
8H Other
Liabilities |
Enter any other personal liabilities. |
8I Total
Personal Liabilities |
Enter the total dollar
amount of all personal liabilities. |
8J Total
Liabilities |
Enter the total amount of Total
Farm Liabilities (Item 6I) and Total Personal Liabilities (Item 8I). |
8K Total
Equity |
Enter the total equity.
(Item 7M minus Item 8J). |
I - Warning |
|
9A Signature |
After reading the warning,
enter signature. |
9B Date |
Enter the date the form is
signed by the applicant. |
10
Comments |
Enter any comments
clarifying information on this form. |
J -
Machinery and Equipment |
|
11A Quantity |
Enter the number of pieces
of equipment to be described in Item 11B. |
11B Description |
Enter the description of
the type of machinery or equipment. |
11C Manufacturer |
Enter the manufacturer�s
name of the equipment listed in Item 11B. |
11D Size/Type |
Enter the size and or type
of equipment listed in Item 11B. |
11E Condition |
Enter the current
condition of the equipment listed in Item 11B. Note:� (E) Excellent, (G) Good,
(A) Average, (F) Fair, (P) Poor Note:� Do not list junk items. |
11F Year |
Enter the year of
manufacture. |
11G Serial
Number |
Enter the serial number
for each item of machinery or equipment. Note:� Notate if serial number is not available. |
11H $
Value |
Enter the current market
value as of the date of the balance sheet. |
11I.
Total
$ Value |
Enter the total of all $
values of 11H. |
K - Farm Vehicles |
|
12A Quantity |
Enter the number of farm vehicles
to be described in Item 12B. |
12B Description |
Enter the description of
farm vehicles. |
12C Manufacturer |
Enter the manufacturer�s
name of the farm vehicle listed in Item 12B. |
12D Size/Type |
Enter the size, type or
model of the farm vehicles listed in Item 12B. |
12E Condition |
Enter the current
condition of the farm vehicle listed in Item 12B. Note:� (E) Excellent, (G) Good, (A) Average, (F)
Fair, (P) Poor Note:� Do not list junk items. |
12F Year |
Enter the year of
manufacture. |
12G Serial
Number/VIN |
Enter the Serial Number or
Vehicle Identification Number (VIN) for farm vehicles listed in Item 12B. |
12H $
Value |
Enter the current market
value as of the date of the balance sheet. |
12I Total
$ Value |
Enter the total of all $
values of 12H. |
12J
Combined Total
$ Value |
Enter the combined total $
value of (Items 11I and 12I). Transfer the amount to 3A. |