AGRICULTURE FINANCIAL STATEMENT Borrower # AND LOAN APPLICATION Telephone # For the purpose of obtaining credit from Ramsey National Bank (RNB) and any future credit granted by the RNB, or to support an extension of credit already given, I (we) make the following financial statement: Applicant: NAME ADDRESS BIRTHDATE DEPENDENTS SOCIAL SECURITY NO. NUMBER Co-Applicant: CURRENT ASSETS AMOUNT CURRENT DEBTS AMOUNT Cash Life Insurance (Amt $ ) Stocks & Bonds Notes - Unsecured Col. Notes & Accounts Crops - Seed Accounts - Feed, Gas Crops - Sale Medical Credit Card Debt Household Goods Owing Relatives Invest Growing Crops RE Int. - Rent - Taxes (Past Due) - Liens Deferred Income Tax Liability INTERMEDIATE (1 to 7 yrs) Terms Yr Due Machinery - Equipment Vehicles TOTAL Last Yr. $ TOTAL Last Yr. $ FIXED ASSETS LONG TERM DEBT Acres Sec. Twp. Range County D or LC Acres To Terms TOTAL LONG TERM Last Yr. $ TOTAL FIXED ASSETS Last Yr. $ TOTAL DEBTS Last Yr. $ TOTAL ASSETS Last Yr. $ NET WORTH Last Yr. R.E. Appreciation This Year $ Contingent Liabilities Rented Land: Terms Landlord Date of Last Financial Statement: Till Acres Sflow Soybea Beans Bly CRP Explain Major Changes:
Page 2 LOAN PURPOSE - Immediate Amount *REPAYMENT PLAN: Alimony, child support or separate maintenance income need not be revealed if applicant or co-applicant does not choose to have it considered as a basis for repaying this loan. Date *Source Amount LOAN PURPOSE - Future Total Immediate Total Loan Requested Total Repayment I (we) represent that this statement is true and authorize the RNB or its agents to verify the information contained in this statement and to obtain additional information concerning my (our) financial condition and furnish the same to others. This statement is the property of RNB. The RNB can consider the statement to continue to be complete and accurate unless written notice is given the RNB to the contrary. I (we) agree to provide the RNB with a current earning statement at any time that I (we) request any future credit or any extension, renewal, modification or refinancing of credit obtained by me (us) from the RNB. The terms and conditions of the repayment plan as noted herein are understood and accepted by me (us). Date _ JOINT APPLICATION: We intend to apply for joint credit. Applicant Initials: Co-Applicant Initials:. Applicant Co-Applicant
EARNINGS WORKSHEET Page 3 APPLICANT: FARM PRODUCTION PERIOD ENDING: / / / / / / TOTAL CASH FARM INCOME (1) Resale Purchase (Always Subtract) (2) Breeding Livestock Purchase (Always Subtract) (3) Livestock Inventory Change Crop and Feed Inventory Change Accounts Receivable Change Net Non-Cash Farm Income VALUE OF FARM PRODUCTION (4) Farm Operating Expense Labor Repairs Interest Rent Feed Seed and Plants Fertilizer and Lime Spray and Chemicals Custom Hire Supplies Breeding - Veterinary Gas - Oil - Fuel Taxes (Expect Income Tax) Insurance - Utilities Marketing Expense TOTAL CASH FARM OPERATING EXPENSE (5) Pepaid Expense Change (Add a; Subtract a-1) Accounts Payable Change Machinery and Equipment Depreciation Building and Improvement Depreciation TOTAL FARM OPERATING EXPENSE (6) Net Farm Earnings (4-6) (7) Net Cash Personal and Non-farm Income (8) Cash Family Living (Always Subtract) (9) Income Tax (Always Subtract) (10) Net Earnings (line 7 plus 8-9-10) Net Cash From Operations (line 1-2-3-5 plus 8-9-10) Capital Sales Other Capital Receipts Change in Checkbook Balance NET CASH AVAILABLE
Use of Cash Available from preceding page Page 4 Real Estate and Improvement Purchases Machinery Purchases Other Capital Outlay TOTAL CAPITAL (11) Changes in Notes Payable (12) TOTAL USE OF CASH AVAILABLE (LINE 11-12) DEBT SERVICING Creditors Secured By Total Debt Interest Principal Total Payment Prepared by: Total Date:
SUPPORTING SCHEDULE Page 5 FOR FINANCIAL STATEMENT OF: Machinery and Equipment Year Make, Kind, and Model (Group by like kind) 20 20 20 TOTAL COLLATERAL ANALYSIS FEED and GRAIN INVENTORY LIVESTOCK COLLATERAL Units Description S or F Val./Unit Total Val. Recov. Val. No. Breed Kind Age Weight Value Total TOTAL $ TOTAL $