BALANCE SHEET MO. DAY YEARSTATEMENT

OF AS OF / / TO First National Bank in Olney

Comract!sl Notes Rte

Amounts From Schedule at 3 SHOW TOTAL ABOVE

Amounts From Schedule at 6

Are you obl11ated to pay alimony, child support, or separate mamlenance?.. . . . D YES D NO Does anyone else own an interest m the property listed? . . ..... . . ... D YES D NO ti YES. who D spouse D other: _________________

What property D real estate D other: ___ _ ______ ____ _

Assets normally sold or CURRENT converted to cash during the year CURRENT ASSETS

VALUE

Cash Savings Accts. Receivable Marketable Sec. Hedging Account Equity Commodities For Sale & Feed

Untl ccco, Kind No. of Units Value Con1racl

Investment in Growing Crops

Feed Fert. Fuel

livestock Held For Sale

Seed Chem. Other Supplies

Number wt. Unit Value

I. CURRENT ASSETS Amounts from Schedule at I

Subtotal I.T. ASSETS Assets not normally sold during the year

Breeding livestock Number Wt.

Auto(s) Truck(s)

Machinery: Beg. S (-) Value Disposed $ 1-1 Depr. S

Marketable Set lite Insurance Rebrement Nott(sJ .t.ccolll'lts Rea1oble

Amounts From Schedule at 2 2. INTERMEDIATE TERM ASSETS Subtotal

LONG TERM ASSETS Real Estate & Improvements

Acres: How rnled Yr. Purch. Orig. Cost lmp,ovement t Since Purchase

3. LOIIG TERII ASSETS Subtotal

TOTAL ASSETS 1 • 2 • 3

I hawe endorsed contract(s) or loan(s) for the followin1 purpose: $

D None

Ale thefe any1udaments ol record aaa1nstyou? . .. DYES O NO Have you been declared bankrupl m the last 14 yrs? ... .. 0 YES ONO Are you a party to a lawwiP · ... . . . D YES ONO Are anyolyour tues dellnquent or underdispute? . . 0 YES O NO

CURRENT LIABILITIES Amounts due ,n I year AMOUNT(S) Creditor(s) Name: OWED

Feed Seed F..-tilizer Chemicals

Fuel

Repairs

Other Accounts

Rent(s)/ lease(s)

Estimated & Accrued:

Income Tax: Soc. Sec.:

R. E. Taxes Property Taxes Accrued I.T. Interest $

Accrued L.T. Interest $

A<..crued lnteies! NOTES TO: Secured By Date Oue Unpaid Principal •

Principal Portion I.T. liabilities due in 12 mos (from below)

Principal Portion long Term l1ab1lties due in 12 mos. (from below)

Amounts From Schedule at 4

4. CURRENT LIABILITIES Subtotal

Debts due in more than l and lessI.T. LIABILITIES than 10 yrs. (less current amounts)

Secu1ed 8y Rate

SHOW TOTAL ABOVE lllelns. LOins

Amounts From Schedule at 5 5. INTERMEDIATE TERM LIABILITIES Subtotal

LONG TERM LIABILITIES %"~.a;:::::.."'!"-.," Owed Secured

To 8-,IAc,es Rate

E1ptainanyYESanswers - - - ----- --------- --- - ---- --- --------------- - ----!Continue on Attachment!

Everything that I / We have stated is correct to the best of my / our knowledge. The foregoing, together with any accompanying schedule, 1s a true, correct and complete statement of my / ou r financial condition as of the date shown above. I / We understand that FNB will retain this statement whether or not credit is approved.

SIGNED I ION SIGNATURE SIGNAIURE

1

2

3

4

5

6

7

CROPSFARMS OPERATED j Yrs. Ste. N ETwp. Ran1t County Acres Opta. No. s wRECORD OWNER in Farm

PRODUCTION j Total Acres j Full Share Acres I Applicant's Full Share Production

Production last yr. (Acres / Yield)

MACHINERY & EQUIPMENT

Amount of (Prior Liens) No. & Description, Yr. Make, Model & Serial No. Valuation

Tractor(s)

Harvest Machine(s)

Plow(s)

Tillage Equipment

Planter(s)

Mower(s)

Wagon(s) & Trailer(s)

Grain Handling Equipment

Livestock Equipment

B. C. D. A. RENTAL Yield TERMSAcres Yield Acres Yield Acres Yield Acres

FARM INSURANCES•

Farm Property

Crop Hail

Federal Crop Ins.

Auto( s)

Truck( s)

Workmen' s Comp.

PERSONAL INSURANCES

life Ins. (Apptic.)

Life Ins.

Disability Income lns.

General Coverages Carried or in Force

Liab.$ Prop. $ Bldgs. S

Ordinary life S Term S

Fa mily Hospilalization

1. Marital Status ( ) Married ( ) Separated ( ) Unmarried (including single, divorced and widowed)

(Do not complet e if this is an application for indiv idual unsecured credit not primarily for agricultural purposes unless you reside in a community property state or property upon which you are relying as a basis for repayment of the credit requested is located in a community property state).

2 . Age of Dependents 3. Your Age Physical Condition

List of other incomes

Source Amount

Source , Amount

Income from alimony, child support and separate maintenance need not be revealed.

If a partnership or Corporation; give detai ls:

Shop Equipment

16. TOTAL VALUATION !MACH. & EQUIP. TOTALS! 13. Valuation

14. Prior Liens I