Instructions for WA-51

FINANCIAL STATEMENT

Warehouse operators use this form to file information for review by the Financial Review Branch in meeting the financial reporting requirements for CCC Storage Agreements.

Submit the original of the completed form in hard copy or facsimile to the Kansas City Commodity Office, Financial Review Branch, STOP 8758, P.O. Box 419205, Kansas City, MO 64141-6205; telephone 816-926-6454 or FAX 816-823-1805. Customers who have established electronic access credentials with KCCO may electronically transmit this form to KCCO.

Features for transmitting the form electronically are available to those customers with access credentials only. If you would like to establish online access credentials with KCCO, follow instructions provided at the USDA eForms web site.

Warehouse Operators must complete Items 1 through 16.

Fld Name / Item No.	Instruction
1A Name	Item 1A. Enter the warehouse operator’s full legal name. See Examples below: Example 1: If a proprietor, enter, for example, “Susan Doe, trading as Doe Warehouse.” Example 2: If a corporation, enter, for example, “Doe, Inc.” Example 3. If a general partnership, enter, for example “Letitia Doe, Frank Doe, Selma Doe, and James Doe, co-partners, trading as Doe Warehouse.” Example 4. If a limited partnership, enter, for example “Doe Warehouse Limited Partnership, Selma Doe, General Partner”
1B – 1C Telephone and FAX Number	Item 1B. Enter applicant’s telephone number. Item 1C. Enter applicant’s FAX number.
2A – 2B Address	Item 2A. Enter the applicant’s complete mailing address. Item 2B. Enter the applicant’s e-mail address.
3 Statement Prepared by	Enter "X" or checkmark to indicate this WA-51 is prepared by an independent Certified Public Accountant, an Independent Public Accountant, or “Other.” If “Other” is checked, explain in Item 26 or on a separate sheet of paper and identify by this WA-51 item number who prepared this WA-51.
4 Form of Business	Enter "X" or checkmark to indicate Corporation (Co-op), regular Corporation, Subchapter S Corporation, Limited Liability Company, Partnership, or Individual Proprietorship.
5 Reserved	Leave blank.
6 Fiscal Closing Date	Enter the date of the fiscal year close (month, day). Note: Notify KCCO, Financial Review Branch, if this date changes.
7 Date of Entity Formation	Enter the date of entity formation. In the case of a corporation, enter the date of incorporation. In the case of a partnership, enter the date the agreement is signed. In the case of an LLC, enter the date documents filed with the secretary of state. In the case of a proprietorship, enter the date company was started.
8A – 9E Organiza-tional Information	Item 8A. If a Corporation, Limited Liability Company (LLC), Partnership, or Individual Proprietorship, enter the name of the president, member, partner, or individual, their home address, home telephone number, and the total number of shares of stock owned, if applicable. Item 8B. If a Corporation, Limited Liability Company (LLC), Partnership, or Individual Proprietorship, enter the name of the vice president, member, partner, or individual, their home address, home telephone number, and the total number of shares of stock owned, if applicable. Item 8C. If a Corporation, Limited Liability Company (LLC), Partnership, or Individual Proprietorship, enter the name of the secretary, member, partner, or individual, their home address, home telephone number, and the total number of shares of stock owned, if applicable. Item 8D. If a Corporation, Limited Liability Company (LLC), Partnership, or Individual Proprietorship, enter the name of the treasurer, member, partner, or individual, their home address, home telephone number, and the total number of shares of stock owned, if applicable. Item 8E. If a corporation, LLC, partnership, or individual proprietor, enter the name of the general manager, their home address, home telephone number, and the total number of shares of stock owned, if applicable.
9A – 9D Directors of Corporation	Item 9A. Enter the name of each of the directors if entity is a corporation. Item 9B. Enter the occupation of each director listed in Item 9A. Item 9C. Enter the home address of each director listed in Item 9A. Item 9D. Enter the number of shares of stock held for each director listed in Item 9A.
10 Company Books Closing Date	Enter the closing date reflected by the company books for this financial statement (month, day, year).
11A – 11L Current Assets	Item 11A. Enter the cash on hand and in banks. Item 11B. Enter the Accounts receivable. Item 11C. Enter Other accounts receivables. Item 11D. Enter Notes receivable-Secured. Trade. Item 11E. Enter Notes receivable-Secured. Other. Item 11F. Enter Notes receivable-Unsecured. Trade. Item 11G. Enter Notes receivable-Unsecured. Other. Item 11H. Enter Reserve for bad debts. Item 11I. Enter total of all receivables (11B through 11G, less 11H). Item 11J. (1) Enter how merchandise inventory is valued. (2) Enter the value of merchandise inventory Item 11K. Enter in Items 11K(1) and 11K(2) Other current assets, including Government securities, and enter the value of each enumerated asset. Item 11K. (3) Enter the total Other Current Assets (add Items 11K(1) and 11K(2). Item 11L. Enter the Total Current Assets (add Items 11A, 11I, 11K(3)).
12A – 12E Fixed Assets	Item 12A. Enter the value of land as fixed assets and identify more fully in Schedule A, Item 15. Item 12B. Enter the Cost for the fixed assets preprinted in the Fixed Assets column. Item 12C. Enter the Depreciation of the fixed assets preprinted in the Fixed Assets column. Item 12D. Enter the Book Value of the fixed assets preprinted in the Fixed Assets column (Item 12B minus 12C). Item 12E. Enter the Total Fixed Assets (add Item 12A and all entries from column 12D).
13A – 13F Other Investments and Assets	Item 13A. Enter other investments and assets in Items 13A through 13D. If additional space is needed, attach a separate sheet to this form identifying the information to this item. Item 13E. Enter the total investments and assets of the other investments and assets specified in Item 13A through 13D.
14 Total Assets	Enter Total Assets (Total Current Assets from Item 11L, Total Fixed Assets from Item 12E, and Total Investments and Assets from Item 13E).
15A – 15C Schedule A, Description of Real Estate	Item 15A. Enter the description of land entered as Fixed Assets Land, Item 12A. Item 15B. Enter the location of the land described in Item 15A. Item 15C. Enter improvements made to the land described in Item 15A.
16A – 16H Current Liabilities	Item 16A. Enter the accounts payable. Item 16B. (1) Enter the Secured Notes Payable due within 1 year. (2) Enter the Unsecured Notes Payable due within 1 year. (3) Enter the total of Items 16B(1) and 16B(2). Item 16C. Enter real estate encumbrances due within 1 year. Item 16D. Enter accrued interest. Item 16E. Enter real estate accrued taxes. Item 16F. Enter other accrued expenses such as other taxes, wages, etc. Item 16G. List other current liabilities and enter the amounts for each in Items 16G(1) through 16G(4). Item 16G. (5) Enter the total of Items 16G(1) through 16G(4). Item 16H. Enter the total current liabilities (add Items 16A through 16G(5)).
17A – 17B Long Term Liabilities	Item 17A. Enter long-term notes payable due after 1 year. Item 17B. (1) Enter long-term real estate encumbrances due after 1 year (describe fully under Schedule B, Item 20). (2) Enter the total of Items 17A and 17(1) in Item 17B(2).
18A – 18G Other Liabilities	Item 18A. Enter Other Liabilities in Items 18A through 18F and enter the value of each. Item 18G. Total the value of Other Liabilities listed in Items 18A through 18F and enter that total in Item 18G.
19A – 19F Net Worth	Item 19A. Enter for Capital the number of shares of authorized common stock, the par value per share, the number of shares issued, and the dollar value of the shares issued. Item 19B. Enter for Capital the number of shares of authorized preferred stock, the par value per share, the number of shares issued, and the dollar value of the shares issued. Item 19C. Enter retained earnings. Item 19D. Enter any other paid in capital, appraisal, members’ equity, partnership equity, individual equity, etc., in Items 19D(1) through 19D(4). If additional space is needed, attach a separate sheet to this form identifying the information to this item number. Item 19D. (5) Enter the total of Items 19D(1) through 19D(4). Item 19E. Enter the total net worth (add Items 19A, 19B, 19C, and 19D(5)) and reconcile under Item 21, Schedule C. Item 19F. Enter the total liabilities and net worth (add Items 16H, 17B(2), 18G, and 19E). Note: This Item 19F should equal Item 14, Total Assets.
20A – 20E Schedule B, Analysis of Real Estate Encumbrances	Item 20A. Enter the nature of each real estate encumbrances. Item 20B. Enter the interest rate for the real estate encumbrance listed in Item 20A. Item 20C. Enter the payment schedule for the real estate encumbrance listed in Item 20A. Item 20D. Enter the maturity date for the real estate encumbrance listed in Item 20A. Item 20E. Enter the balance due for the real estate encumbrance listed in Item 20A.
21A – 21F Schedule C, Reconciliation of Net Worth	Item 21A. Enter the capital outstanding if a corporation. Item 21B. Enter retained earnings if a corporation. Item 21C. Enter the capital account if a partnership or other. Item 21D. (1). Enter the stock issued during this accounting period. Item 21D. (2). Enter the net profit during this accounting period. Item 21D. (3). Enter any other additional net worth during this accounting period and explain on a separate sheet of paper (identify by this WA-51 item number). Item 21D. (4). Enter the total of Items 21D(1) through 21D(3). Item 21E (1). Enter deductions for stocks retired during this accounting period. Item 21E (2). Enter net operating loss during this accounting period. Item 21E (3). Enter any other deduction in net worth and explain on a separate sheet of paper (identify by this WA-51 item number). Item 21E. (4). Enter the total of Items 21E(1) through 21E(3). Item 21F. Enter the Total Net Worth for this WA-51 (add Items 21A through 21D(4) less Item 21E(4)). Note: The amount entered in Item 21F should be the same as Item 19E.
22A – 22B General Information	Item 22A. Enter any assets listed in Items 11 through 15 that are exempt from execution and levy. Item 22B. Enter the grounds exemption is claimed for those assets listed in Items 11 through 15.
23A – 23C Banks	Item 23A. Enter the name of each bank where business is done. Item 23B. Enter the location of each bank listed in Item 23A. Item 23C. Enter the amount of the line of credit for the bank listed in Item 23A.
24 Fire Loss	Enter the fire loss suffered, if any, since the previously submitted financial statement.
25A – 25D Fire Insurance Coverage	Item 25A. Enter the amount of fire insurance coverage on buildings. Item 25B. Enter the amount of fire insurance coverage on fixtures and equipment. Item 25C. Enter the amount of fire insurance coverage on merchandise inventory, if any. Item 25D. Enter storage obligations, if any. Note: The amounts shown in Items 25A through 25C must apply only to corresponding assets shown on the balance sheet.
26 Contingent Liabilities	Describe any contingent liabilities, if any, which are not shown in Items 16 through 20, in this space or on a separate sheet of paper and identify by this WA-51 item number.
27 Remarks	Enter in this space or on a separate sheet of paper (identify by WA-51 item number) any information needed to interpret or clarify the financial information presented.
28A – 28D Certification	Item 28A. Enter the name of the operating entity as shown in Item 1A. Item 28B. Enter the signature of the applicant. Item 28C. Enter the business title of the individual signing for the operating entity. Item 28D. Enter the date of signature. If you are mailing or faxing this form, print the form, and enter the signature of an authorized individual, i.e., a corporate officer, partner, or proprietor. If this form is approved for electronic transmission and you have established credentials with USDA to submit forms electronically, use the buttons provided on the form for transmitting the form to the Kansas City Commodity Office.

Fld Name /
Item No.

Instruction

Name

Item 1A. Enter the warehouse operator’s full legal name. See Examples below:

Example 1: If a proprietor, enter, for example, “Susan Doe, trading as Doe Warehouse.”

Example 2: If a corporation, enter, for example, “Doe, Inc.”

Example 3. If a general partnership, enter, for example “Letitia Doe, Frank Doe, Selma Doe, and James Doe, co-partners, trading as Doe Warehouse.”

Example 4. If a limited partnership, enter, for example “Doe Warehouse Limited Partnership, Selma Doe, General Partner”

1B – 1C

Telephone and FAX Number

Item 1B. Enter applicant’s telephone number.

Item 1C. Enter applicant’s FAX number.

2A – 2B

Address

Item 2A. Enter the applicant’s complete mailing address.

Item 2B. Enter the applicant’s e-mail address.

Statement Prepared by

Enter "X" or checkmark to indicate this WA-51 is prepared by an independent Certified Public Accountant, an Independent Public Accountant, or “Other.” If “Other” is checked, explain in Item 26 or on a separate sheet of paper and identify by this WA-51 item number who prepared this WA-51.

Form of Business

Enter "X" or checkmark to indicate Corporation (Co-op), regular Corporation, Subchapter S Corporation, Limited Liability Company, Partnership, or Individual Proprietorship.

Reserved

Leave blank.

Fiscal Closing Date

Enter the date of the fiscal year close (month, day).

Note: Notify KCCO, Financial Review Branch, if this date changes.

Date of Entity Formation

Enter the date of entity formation. In the case of a corporation, enter the date of incorporation. In the case of a partnership, enter the date the agreement is signed. In the case of an LLC, enter the date documents filed with the secretary of state. In the case of a proprietorship, enter the date company was started.

8A – 9E

Organiza-tional Information

Item 8A. If a Corporation, Limited Liability Company (LLC), Partnership, or Individual Proprietorship, enter the name of the president, member, partner, or individual, their home address, home telephone number, and the total number of shares of stock owned, if applicable.

Item 8B. If a Corporation, Limited Liability Company (LLC), Partnership, or Individual Proprietorship, enter the name of the vice president, member, partner, or individual, their home address, home telephone number, and the total number of shares of stock owned, if applicable.

Item 8C. If a Corporation, Limited Liability Company (LLC), Partnership, or Individual Proprietorship, enter the name of the secretary, member, partner, or individual, their home address, home telephone number, and the total number of shares of stock owned, if applicable.

Item 8D. If a Corporation, Limited Liability Company (LLC), Partnership, or Individual Proprietorship, enter the name of the treasurer, member, partner, or individual, their home address, home telephone number, and the total number of shares of stock owned, if applicable.

Item 8E. If a corporation, LLC, partnership, or individual proprietor, enter the name of the general manager, their home address, home telephone number, and the total number of shares of stock owned, if applicable.

9A – 9D

Directors of Corporation

Item 9A. Enter the name of each of the directors if entity is a corporation.

Item 9B. Enter the occupation of each director listed in Item 9A.

Item 9C. Enter the home address of each director listed in Item 9A.

Item 9D. Enter the number of shares of stock held for each director listed in Item 9A.

Company Books Closing Date

Enter the closing date reflected by the company books for this financial statement (month, day, year).

11A – 11L

Current Assets

Item 11A. Enter the cash on hand and in banks.

Item 11B. Enter the Accounts receivable.

Item 11C. Enter Other accounts receivables.

Item 11D. Enter Notes receivable-Secured. Trade.

Item 11E. Enter Notes receivable-Secured. Other.

Item 11F. Enter Notes receivable-Unsecured. Trade.

Item 11G. Enter Notes receivable-Unsecured. Other.

Item 11H. Enter Reserve for bad debts.

Item 11I. Enter total of all receivables (11B through 11G, less 11H).

Item 11J. (1) Enter how merchandise inventory is valued.

(2) Enter the value of merchandise inventory

Item 11K. Enter in Items 11K(1) and 11K(2) Other current assets, including Government securities, and enter the value of each enumerated asset.

Item 11K. (3) Enter the total Other Current Assets (add Items 11K(1) and 11K(2).

Item 11L. Enter the Total Current Assets (add Items 11A, 11I, 11K(3)).

12A – 12E

Fixed Assets

Item 12A. Enter the value of land as fixed assets and identify more fully in Schedule A, Item 15.

Item 12B. Enter the Cost for the fixed assets preprinted in the Fixed Assets column.

Item 12C. Enter the Depreciation of the fixed assets preprinted in the Fixed Assets column.

Item 12D. Enter the Book Value of the fixed assets preprinted in the Fixed Assets column (Item 12B minus 12C).

Item 12E. Enter the Total Fixed Assets (add Item 12A and all entries from column 12D).

13A – 13F

Other Investments and Assets

Item 13A. Enter other investments and assets in Items 13A through 13D. If additional space is needed, attach a separate sheet to this form identifying the information to this item.

Item 13E. Enter the total investments and assets of the other investments and assets specified in Item 13A through 13D.

Total Assets

Enter Total Assets (Total Current Assets from Item 11L, Total Fixed Assets from Item 12E, and Total Investments and Assets from Item 13E).

15A – 15C

Schedule A, Description of Real Estate

Item 15A. Enter the description of land entered as Fixed Assets Land, Item 12A.

Item 15B. Enter the location of the land described in Item 15A.

Item 15C. Enter improvements made to the land described in Item 15A.

16A – 16H

Current Liabilities

Item 16A. Enter the accounts payable.

Item 16B. (1) Enter the Secured Notes Payable due within 1 year.

(2) Enter the Unsecured Notes Payable due within 1 year.

(3) Enter the total of Items 16B(1) and 16B(2).

Item 16C. Enter real estate encumbrances due within 1 year.

Item 16D. Enter accrued interest.

Item 16E. Enter real estate accrued taxes.

Item 16F. Enter other accrued expenses such as other taxes, wages, etc.

Item 16G. List other current liabilities and enter the amounts for each in Items 16G(1) through 16G(4).

Item 16G. (5) Enter the total of Items 16G(1) through 16G(4).

Item 16H. Enter the total current liabilities (add Items 16A through 16G(5)).

17A – 17B

Long Term Liabilities

Item 17A. Enter long-term notes payable due after 1 year.

Item 17B. (1) Enter long-term real estate encumbrances due after 1 year (describe fully under Schedule B, Item 20).

(2) Enter the total of Items 17A and 17(1) in Item 17B(2).

18A – 18G

Other Liabilities

Item 18A. Enter Other Liabilities in Items 18A through 18F and enter the value of each.

Item 18G. Total the value of Other Liabilities listed in Items 18A through 18F and enter that total in Item 18G.

19A – 19F

Net Worth

Item 19A. Enter for Capital the number of shares of authorized common stock, the par value per share, the number of shares issued, and the dollar value of the shares issued.

Item 19B. Enter for Capital the number of shares of authorized preferred stock, the par value per share, the number of shares issued, and the dollar value of the shares issued.

Item 19C. Enter retained earnings.

Item 19D. Enter any other paid in capital, appraisal, members’ equity, partnership equity, individual equity, etc., in Items 19D(1) through 19D(4). If additional space is needed, attach a separate sheet to this form identifying the information to this item number.

Item 19D. (5) Enter the total of Items 19D(1) through 19D(4).

Item 19E. Enter the total net worth (add Items 19A, 19B, 19C, and 19D(5)) and reconcile under Item 21, Schedule C.

Item 19F. Enter the total liabilities and net worth (add Items 16H, 17B(2), 18G, and 19E).

Note: This Item 19F should equal Item 14, Total Assets.

20A – 20E

Schedule B,

Analysis of Real Estate Encumbrances

Item 20A. Enter the nature of each real estate encumbrances.

Item 20B. Enter the interest rate for the real estate encumbrance listed in Item 20A.

Item 20C. Enter the payment schedule for the real estate encumbrance listed in Item 20A.

Item 20D. Enter the maturity date for the real estate encumbrance listed in Item 20A.

Item 20E. Enter the balance due for the real estate encumbrance listed in Item 20A.

21A – 21F

Schedule C,

Reconciliation of Net Worth

Item 21A. Enter the capital outstanding if a corporation.

Item 21B. Enter retained earnings if a corporation.

Item 21C. Enter the capital account if a partnership or other.

Item 21D. (1). Enter the stock issued during this accounting period.

Item 21D. (2). Enter the net profit during this accounting period.

Item 21D. (3). Enter any other additional net worth during this accounting period and explain on a separate sheet of paper (identify by this WA-51 item number).

Item 21D. (4). Enter the total of Items 21D(1) through 21D(3).

Item 21E (1). Enter deductions for stocks retired during this accounting period.

Item 21E (2). Enter net operating loss during this accounting period.

Item 21E (3). Enter any other deduction in net worth and explain on a separate sheet of paper (identify by this WA-51 item number).

Item 21E. (4). Enter the total of Items 21E(1) through 21E(3).

Item 21F. Enter the Total Net Worth for this WA-51 (add Items 21A through 21D(4) less Item 21E(4)).

Note: The amount entered in Item 21F should be the same as Item 19E.

22A – 22B

General Information

Item 22A. Enter any assets listed in Items 11 through 15 that are exempt from execution and levy.

Item 22B. Enter the grounds exemption is claimed for those assets listed in Items 11 through 15.

23A – 23C

Banks

Item 23A. Enter the name of each bank where business is done.

Item 23B. Enter the location of each bank listed in Item 23A.

Item 23C. Enter the amount of the line of credit for the bank listed in Item 23A.

Fire Loss

Enter the fire loss suffered, if any, since the previously submitted financial statement.

25A – 25D

Fire Insurance Coverage

Item 25A. Enter the amount of fire insurance coverage on buildings.

Item 25B. Enter the amount of fire insurance coverage on fixtures and equipment.

Item 25C. Enter the amount of fire insurance coverage on merchandise inventory, if any.

Item 25D. Enter storage obligations, if any.

Note: The amounts shown in Items 25A through 25C must apply only to corresponding assets shown on the balance sheet.

Contingent Liabilities

Describe any contingent liabilities, if any, which are not shown in Items 16 through 20, in this space or on a separate sheet of paper and identify by this WA-51 item number.

Remarks

Enter in this space or on a separate sheet of paper (identify by WA-51 item number) any information needed to interpret or clarify the financial information presented.

28A – 28D

Certification

Item 28A. Enter the name of the operating entity as shown in Item 1A.

Item 28B. Enter the signature of the applicant.

Item 28C. Enter the business title of the individual signing for the operating entity.

Item 28D. Enter the date of signature.

If you are mailing or faxing this form, print the form, and enter the signature of an authorized individual, i.e., a corporate officer, partner, or proprietor. If this form is approved for electronic transmission and you have established credentials with USDA to submit forms electronically, use the buttons provided on the form for transmitting the form to the Kansas City Commodity Office.