Balance Sheet

as of (date)

Name Customer No.

ASSETS / LIABILITIES
Cash on hand or in checking / Operating line
Savings accounts and time certificates / Creditor Maturity Rate Total Commitment
Marketable securities
Type Quantity $/Share Maturity Rate / Accounts payable
Creditor Maturity Rate
Accounts receivable
Debtor Maturity Rate
CCC loans
Maturity Rate
Note/Contract principal (due within 12 months)
Debtor Maturity Rate
Accrued rent/taxes
Accrued interest / Accrued interest
Products on hand (Sch. A) / Note/Mtg/Contract principal (due within 12 months)
Growing crops (Sch. B) / Creditor Date due
Marketable livestock (Sch. C)
Prepaid expenses
Supplies
Commodity account equity
Other / Other
TOTAL CURRENT ASSETS / TOTAL CURRENT LIABILITIES / 16,000
Machinery, equipment (Sch. E) / Notes (less current portion)
Irrigation equipment (Sch. E) / Creditor Rate Term Payment Last paid
Personal and recreational vehicles (Sch. E)
Production livestock
Retirement accounts
Life insurance - cash value / Life insurance policy loan
Securities not readily marketable (please describe) / Creditor Rate Term Payment Last paid
Capital leases (less current portion
Creditor Rate Term Payment Last paid
Household and personal goods
FCS stock
Co-op stock
Real estate / Mortgages/Contracts (less current portion
Tract County Acres Acquired Price / Creditor Rate Term Payment Last paid
Notes and contracts receivable (less current portion) / Other (less current portion)
Debtor Rate Term Payment Last paid / Creditor Rate Term Payment Last paid
Contingent liabilities (do not include in totals)
Other / Creditor Rate Term Payment Last paid
TOTAL NON-CURRENT ASSETS / TOTAL NON-CURRENT LIABILITIES
TOTAL ASSETS / TOTAL LIABILITIES
NET WORTH

I (we) certify that the information provided in the above financial statement is complete and accurate to the best of my (our) knowledge. I (we) understand that a false statement or report of facts material to the approval of a loan, knowingly made, may subject the maker to criminal liability under Federal criminal statutes as well as civil liability.

(Date) (Date)

Sch. A - Products on Hand (S=Sale, U=Use) / Sch. B - Growing Crops (C=Cash Invest., M=Mature)
S/U Product Location Quantity % Share Price/Unit / C/M Tract Crop Acres % Share Price/Unit
TOTAL / TOTAL
Sch. C - Marketable Livestock / Sch. D - Production Livestock (Breeding, Dairy, etc.)
Kind Location Quantity % Share Price/Head / Kind Location Quantity % Share Price/Head
TOTAL / TOTAL
Sch. E - Machinery/Equipment, Irrigation Equipment & Vehicles
Qty. / Year / Make / Model / Size / Item / Serial No. / Condition / Name of Joint Owner
Sch. F - Miscellaneous

ACA 1005 (11/02)