Spreadsheet: 644f869b-84d0-47dd-9e4d-e23962fa066e
Sheet: Sheet1

Unnamed: 0 | Unnamed: 1 | Unnamed: 2 | Unnamed: 3 | Unnamed: 4 | Unnamed: 5 | Unnamed: 6 | Unnamed: 7 | Unnamed: 8 | Unnamed: 9 | Unnamed: 10 | Unnamed: 11 | Unnamed: 12 | Unnamed: 13
AgChoice Farm Credit, ACA
FINANCIAL INFORMATION
 |  |  |  |  |  |  |  | Submitted By:
THE INFORMATION SET FORTH BELOW AND ON THE REVERSE  SIDE IS |  |  |  |  |  |  |  | Other Applicant:
SUBMITTED FOR THE PURPOSE OF OBTAINING  CREDIT AND/OR INDUCING |  |  |  |  |  |  |  | Street Address:
AGCHOICE FARM CREDIT, ACA TO MAKE OTHER FINANCIAL |  |  |  |  |  |  |  | City, State & Zip Code:
ACCOMMODATIONS, ALL FOR WHICH THE UNDERSIGNED IS/ARE WILLING TO |  |  |  |  |  |  |  | Phone:
BECOME LIABLE FOR PAYMENT |  |  |  |  |  |  |  |  | (HOME) |  | (WORK) | (CELL) | (FAX)
 |  |  |  |  |  | Non- Business Employment Status
 |  | Principal [NAME] |  |  |  |  |  | Other Applicant Salary
Employer's Name................................….
Employer's Address............................…
Type of Business..................................…
Position Occupied................................…
Name & Title of Superior.....................…
No of Years in Present Employment …
Other Non-Business Income (gross) … |  |  | $ |  |  |  |  |  | $
 |  |  |  |  | Balance Sheet as of
 |  |  |  |  |  |  |  | (date)
 |  |  |  |  |  | Complete Supplemental Schedules Where Appropriate
 |  | ASSETS (Dollar Value) |  |  |  |  |  |  | LIABILITIES (Dollar Value)
I am the legal owner of the following assets: |  |  |  |  |  |  |  | I owe the following debt: | Purpose of | Date | Original | Repayment | Present
 |  |  |  |  |  |  |  |  | Debt | Incurred | Amount | Schedule | Balance
Cash |  |  |  |  |  |  |  | Income Tax (US, State)
Accounts Receivable |  |  |  |  |  |  |  | Taxes (Real Estate, Etc.)
Notes Receivable |  |  |  |  |  |  |  | Acc. Payable (fuel-repairs)
 |  |  |  |  |  |  |  | Acc. Payable (timber)
Standing Timber (to be cut in next 12 months) |  |  |  |  | schedule A
Logs on Hand |  |  |  |  | schedule B
Lumber on Hand |  |  |  |  | schedule C |  |  | Notes Payable
Mulch, Sawdust, Chips |  |  |  |  | schedule D
Timber Contracts (to be completed in 12 months) |  |  |  |  | schedule E
Stocks and Bonds |  |  |  |  | (H) |  |  | Loans on Life Insurance
Other |  |  |  |  | (F)
 |  |  |  |  |  |  |  | All Other Current Debts
 |  |  |  | Current Assets |  | 0 |  | Current Portion Term Debt
 | Autos
Logging Equipment |  |  |  |  |  |  |  |  | Current Liabilities |  |  |  | 0
[NAME] |  |  |  |  |  |  |  | Notes Payable
Rolling Stock (trucks and trailers)
Timber Contracts (greater than 12 months)
Standing Timber (held greater than 12 months)
Life Insurance Cash Value
Stock and Equities in AgChoice Farm Credit
Other |  |  |  |  |  |  |  | Other IT Debts
 |  |  | Intermediate Assets |  |  | 0 |  | Financial Leases
Timberland (land only if timber value above) |  |  |  |  | Acres |  |  |  | Intermediate Liabilities |  |  |  | 0
Timberland (land only if timber value above) |  |  |  |  | Acres |  |  | Mortgages
Timberland (land only if timber value above) |  |  |  |  | Acres
Residence
Leasehold Improvements (mill site)
Sales Contract receivable |  |  |  |  |  |  |  | Other                     schedule G
Other Real Estate |  |  |  |  | schedule I |  |  |  | Long Term Liabilities |  |  |  | 0
 |  |  |  |  |  |  |  |  | Total Liabilities |  |  |  | 0
 |  |  |  | Fixed Assets |  | 0
 |  |  |  | Total Assets |  | 0 |  |  | Net Worth |  |  |  | 0
 |  | Contingent Liabilities
 |  |  |  |  |  |  |  |  | CERTIFICATION
Are there lawsuits pending against you? |  |  |  |  |  |  |  | By signature hereto, the undersigned certifies the information set forth above and on page 2
Yes |  |  | No |  |  |  |  | is true and correct, containing no material representations or omissions.  The undersigned
Endorsed or cosigned loans for others? |  |  |  |  |  |  |  | further authorizes Farm Credit to obtain a consumer credit report and to verify other credit
Yes |  |  |  | Amount |  |  |  | information, including past and present references from  other creditors and trade account
No |  |  |  |  |  |  |  | balances.  A copy of this consent shall be as effective as the original
Annual operating lease payments |  |  |  | Amount
Annual legal obligation for
payments in support of children-
spouse of previous marriage(s) |  |  |  | Amount |  |  |  | date | Signature
Other contingent liabilities (e.g.,
letters of credit outstanding)? |  |  |  | Amount
 |  |  | Insurance Coverage
 |  | Type |  |  | Amount | Agency |  | date | Signature
Life |  |  |  | $
 |  |  |  | $
Buildings |  |  |  | $
Equipment |  |  |  | $ |  |  |  | date | Signature
Livestock |  |  |  | $
Liability |  |  |  | $
 |  |  |  |  |  |  |  | date | Signature
|::