To: Logansport Savings Bank Name Birth Date Address Co-Owner Birth Date Telephone No. Date of Financial Statement (Use Nearest $)

Size: px

Start display at page:

Download "To: Logansport Savings Bank Name Birth Date Address Co-Owner Birth Date Telephone No. Date of Financial Statement (Use Nearest $)"

Paulina Gilmore
5 years ago
Views:

2 To: Logansport Savings Bank Name Birth Date Address Co-Owner Birth Date Telephone No. Date of Financial Statement (Use Nearest $) ASSETS LIABILITIES Current Assets Cash on Hand Deposits - Current Liabilities - Due Within 1 Year Accounts Payable (J) Notes Payable (H) Total, Col. (a) - Other (Bank) Life Insurance (G) Total, Col. (b) Savings - Bank Interest Due - Accounts Receivable (D) - Others Notes Receivable (E) Taxes Due Stocks and Bonds (F) Feeding Livestock (A-1) Grain and Farm Products (B) Current Potion - R.E. Loans (C) Total, Col. (b) Current Portion - Notes Payable (H) Col. (a) Current Portion - Equipment Leases (L), Col. (a) Crop Cost - Rent, Fertilizer, Fuel, etc. Other - Other - Total Current Liabilities Intermediate and Long Term Liabilities Total Current Assets Intermediate Assets Breeding Livestock (A-2) Notes Payable (H), Col. (b) R.E. Loans (C), Col. (c) Equipment Leases (L), Col. (b) & (c) Cash Value - Life Insurance (G) Other - Machinery and Equipment (K) Personal Auto(s) Total Intermediate and Long Term Liabilities IRAs, 401(k), 403(b), Retirement Funds Long Term Assets TOTAL LIABILITIES Real Estate (C) Total, Col. (a) Other - NET WORTH Total Intermediate & Long Term Assets TOTAL ASSETS TOTAL LIABILITIES AND NET WORTH TAXES Paid for Year - Yes No ALIMONY, CHILD SUPPORT, OR SEPARATE Who prepared Tax Returns? MAINTENANCE INCOME NEED NOT BE Any Suits or Judgements Pending? Yes No REVEALED IF YOU DO NOT WISH TO HAVE Have You Ever Filed Bankruptcy? Yes No IT CONSIDERED AS A BASIS FOR REPAYING THIS OBLIGATION. To obtain or maintain credit on my signature as maker or endorser or otherwise, I certify this financial statement is correct as of this date, and agree to give written notice of change. SIGNATURE SOCIAL SECURITY NO. SIGNATURE SOCIAL SECURITY NO. Page 2

3 FEEDING LIVESTOCK (A-1) ACCOUNTS RECEIVABLE (D) No. Wgt Price Total Value Name Amount Calves w/cows Calves Feeders Feeders Pigs w/sows Feeder Pigs Lambs Total Total Feeding Livestock Name N0TES RECEIVABLE (E) Amount BREEDING LIVESTOCK (A-1) No. Wgt Price Total Value Cows - Dairy Cows - Beef Calves Heifers Heifers - Bred Bulls Total Sows Sows STOCKS and BONDS (F) Gilts Name Shares Price Amount Boars Ewes Lambs Total Breeding Livestock GRAIN and FARM PRODUCTS (B) No. Growing Total Value Acres Corn 0 Total Acres Soybeans 0 Acres Wheat ACCOUNTS PAYABLE (J) Acres Hay Payable To For Amount Bu. On Hand Price Corn Soybeans Wheat Bales Hay Bales Straw Ton Silage Tons Com'l Feed Seeds Total Farm Products Page 3 Total

4 MACHINERY and EQUIPMENT (K) Present Bank Collateral No. Item Make Year Model Value Value Auto Auto Truck Truck Semi Semi Semi Semi Trailer Semi Trailer Semi Trailer Field Cultivator Disc Disc Chisel/Plow Vertical Tillage Rolling Harrow Planter Grain Drill Seed Tender Rotary Hoe Combine Corn Head Grain Head Header Cart Grain Cart Gravity Wagons Auger Auger Sprayer Fork Lift Back Hoe Skid Steer Baler Mower/Conditioner Rake Elevator Hay Wagons Manure Spreader Small Tools Page 4

5 REAL ESTATE (C) (a) (b) (c) Present Principal Principal Mtg Details: Creditor Tillable Purchase Year Present Debt Due Due Over or When Due Acres County Twp. Acres Price Pur. Value Balance 1 Year 1 Year Cont. Pmt. Terms Title Holders NOTES PAYABLE (H) (a) (b) Current Principal Due Principal Due Payable to Debt Balance 1 Year Over 1 Year Secured By When Payable Other Bank - Other Bank - Others Others Page 5

6 LEASED EQUIPMENT (L) (a) (b) (c) When Total Pymts Due Pymts Due Payable To Item Leased Payable Amount 1 Year Over 1 Year Residual LIFE INSURANCE (G) Year Face Cash Name of Company Beneficiary Taken Type Value Value Loans RENTED LAND Basis Lease Oral or Landlord Acres Tillable Rented Expires Written Locations GENERAL INFORMATION Have You Guaranteed Any Loans or endorsed or Co-signed For Others? If So, Show Details Below: Borrower Lender Amount Page 6

AGRICULTURE PROPERTY SECTION SCHEDULED AND UNSCHEDULED FARM PERSONAL PROPERTY CARRIER

AGENCY AGRICULTURE PROPERTY SECTION SCHEDULED AND UNSCHEDULED FARM PERSONAL PROPERTY CARRIER DATE (MM/DD/YYYY) NAIC CODE POLICY NUMBER NAMED INSURED(S) ACCOUNT NUMBER GENERAL INFORMATION 1. IS ANY PROPERTY