Financial Statement (Agricultural) Individual Partnership Phone: By Name:_____________________________ Address:_______________________________________ To:                                                                                                      Date of Statement: ASSETS   LIABILITIES   CURRENT ASSETS   CURRENT LIABILITIES (Due within 12 Months)   Cash   Notes Due this Bank secured   Crops or Feed on Hand (Schedule F)                                  unsecured   Livestock Held for Sale (Schedule D)   Notes to Others        secured          (included CCC loans)   Marketable Bonds and Securities      (Schedule C)                                  unsecured   Accounts Receivable   Accounts Payable       (gas, feed repairs, vet, etc.)           Notes Receivable               Cash Invested in Growing Crops      (Schedule F)   Portion Intermediate and Long Term Debt Due within 12 Months   Other Current Assets   Taxes Income, Real and Personal       Rent       Other Depts Due within 12 Months                   TOTAL—Current Assets   TOTAL—Current Liabilities   INTERMEDIATE TERM ASSETS   INTERMEDIATE TERM LIABILITIES   Cash Value Life Insurance (Schedule B)   Portion of loans of more than 12 Months on:   Machinery, Equipment, Cars, Trucks (Schedule G)     Machinery and Equipment           Breeding Stock (Schedule E)       Securities (not readily marketable) (Schedule C)     Breeding Stock   Household Furnishings and Equipment       Other Intermediate Assets     Life Insurance (Schedule B)         Household Furnishings and      Equipment       Lease Payments Due Beyond 1 Year       Other Intermediate Term Liabilities           TOTAL—Intermediate Assets   TOTAL—Intermediate Liabilities     LONG TERM OR FIXED ASSETS   LONG TERM LIABILITIES   Farm Real Estate (Schedule A)   Real Estate Mortgages (Schedule A Except that portion listed under Current Liabilities               Other Real Estate (Schedule A)   TOTAL—Long Term Liabilities       TOTAL LIABILITES   TOTAL—Fixed Assets   PRESENT NET WORTH   TOTAL ASSETS   TOTAL LIABILITES & NET WORTH   SCHEDULE A—Real Estate—Owned or Rented Title Held By Description (County, Twp, Etc.) Acres Year Purchased Present Value Mortgage Date Due Owned                                                       Rented     Type Lease                          Expires                 For purpose of securing credit from time to time this statement is furnished and is certified to be true and correct. I (or We) agree to notify said bank promptly of any material change herein. Date_________________________________, 20____ Signature_____________________________________ Witness______________________________________ Signature_____________________________________   1. Name of Spouse 7. Your Age          Physical Condition 2. Ages of Children at Home 8. Hvae you been involved in bankruptcy?      Yes    No 3. Insurance Crops                                 $ 9. Are any suits pending against you?           Yes    No 4. Insurance on Buildings (Fire, Ext. Cov.)$ 10. Do you carry health, accident or hospital insurance?                                                  Yes    No 5. Insurance on Machinery, Equipment              and Livestock                           $ 11. Liablity Insurance Coverage            $ 6. List Contingent Liabilities   If a Partnership Give Detail:   Name Partners                    Address                                        Per Cent Interest SCHEDULE B—Life Insurance (include credit life) Insurance Company Beneficiary Face Value Cash Value Amt. Borrowed Due From Whom                                                         SCHEDULE C—Bonds and Securities (in your name) No. of Shares or Par Value Bonds Description Market Value                               SCHEDULE D—Livestock Held for Sale Number Description Wt. Price Value                                                     SCHEDULE E—Breeding Stock Number Description Age Wt. Price Value                                                             SCHEDULE F—Crops or Feed on Hand or Growing (your share only) Crop or Feed Amt. on Hand Bu. or Tons Total Value Acres in Crops Cash Invested "in Crop Owned Rented                                                                                                 TOTALS           SCHEDULE G—Machinery, Equipment, Cars, Trucks (your share only) No. Make Kind Model Year Description Value     Tractor                                                                     Combine             C. Picker             Planter             Plow                                         Disc.             Cultivator             Drill             Man. Sp.             Wagon                                         For. Harv.             Mower             Baler             Rake             Sprayer             Elevator                           Grain Dryer                           Auto                           Truck                           Lvstk Eq.                           Misc.                                                                 TOTALS