Applicant's Legal Name:

Co-Applicant:
Social Security Number
Street Address:

Co App:

City, State Zip:

Cell Phone Number
Email Address

Contact us at (800) 589-7848 or

visit us at www.firstbankofberne.com

Farm Financial Statement

*Enter a Balance Sheet date; Formulas will not work without a date*

Balance Sheet Date:

ASSETS

LIABILITIES

Current Assets
Cash, Checking, Savings

Sch. 1

Cash Value in Life Insurance

Marketable Securities
Hedging Account Equity

Sch. 2
Sch. 3A
(attach

broker's statement)

Notes & Accounts Receivable

Current Liabilities
Accounts Payable

Sch. 10

Notes Payable, Operating

Notes Payable, CCC
Accrued Property & Income Taxes
Due to Relatives
Loans on Life Ins. Cash Value

Crop Inventory
Feed Inventory
Market Livestock Inventory

Sch. 4
Sch. 5
Sch. 5
Sch. 6

Current Portion Long Term Debt

Real Estate
Sch. 9
Intermediate
Sch. 12
Capitalized Lease
Sch. 13

Investment in Growing Crops

Prepaid Expenses

Sch. 7
Sch. 7

Other
Accrued interest

Supplies
Coop Retains Receivable
Other Current Assets

Sch. 7
Sch. 4

Other Current Liabilities

(Portion Due within 12 mos)

TOTAL CURRENT ASSETS

Noncurrent Assets
Breeding Livestock
Miscellaneous Livestock
Non-marketable Securities
Due from Partners or Relatives
Machinery & Equipment
Real Estate
Notes Receivable
(Due after 12 months)
Investment in Coops/Retains
Household Goods
Farm/Business Ventures
Other Fixed Assets
TOTAL NONCURRENT ASSETS

Sch. 11
Sch. 5

Sch. 2

(Sch. 9, 11, & 12)

TOTAL CURRENT LIABILITIES

Noncurrent Liabilities
Sch. 6
Sch. 6
Sch, 3B

Intermediate Debt
(balance less current portion)

Capitalized Lease Debt

(balance less current portion)

Sch. 8
Sch. 9

Real Estate Debt

(balance less current portion)

Sch. 12
Sch. 13
Sch. 9

Other Long Term Liabilities

Sch. 4
Sch. 4
Sch.14

TOTAL NONCURRENT LIABILITIES

TOTAL LIABILITIES
OWNER'S EQUITY
TOTAL LIABILITIES & EQUITY

TOTAL ASSETS

RATIOS
Current Ratio

Debt/Equity Ratio

Working Capital
The foregoing Balance Sheet including the attached schedules 1 through 14 is submitted for the purpose of obtaining new credit or continue existing credit of the undersigned or to
support credit for others based on the guaranty of the undersigned. The undersigned acknowledges and understands that First Bank of Berne (Lender) is relying on the information
provided in this Balance Sheet to make a decision on such requested credit. Undersigned gives Lender authorization to retain Balance Sheet and supporting schedules, whether or
not Lender approves loan request.
Each of the undersigned represents, warrants, and certifies that the information provided herein is true, correct, and complete. In addition, the undersigned will promptly notify
Lender of any subsequent substantial changes in financial condition.
Each of the undersigned agree that even though this Balance Sheet may support a proposed or existing business purpose loan(s), the Lender is authorized to order a consumer
credit report to verify loan information contained herein for as long as the proposed or existing loan(s) remain payable to Lender.

Applicant Signature and Title (if applicable)

Date Signed

Co-applicant Signature and Title (if applicable)

Date Signed

First Bank of Berne

Page 1 of 17

SCHEDULE 1: CASH, CHECKING, SAVINGS

Bank Name

Account #

Amount

1 Checking
2
3
4 Savings
5
6 Cash on Hand
TOTAL

SCHEDULE 2: LIFE INSURANCE

Life Insurance Company

Person Insured

Beneficiary

Face Amount

Cash Value

Amount Borrowed
(if any)

1
2
3
TOTALS

SCHEDULE 3A: MARKETABLE SECURITIES

Description (attach list if necessary)

Owners Name(s)

If Pledged, to
Whom

No of
Stock Exchange Shares

Price per
Share

Value

1
2
3
4
TOTAL $

TOTAL $

SCHEDULE 3B: NON-MARKETABLE SECURITIES INCLUDING RETIREMENT ACCTS- IRA's, 401 K, ETC
1
2
3
4

SCHEDULE 4: NOTES & ACCOUNTS RECEIVABLE AND COOP RETAINS RECEIVABLE

Payment Interest
Amount Due
Due From
Freq.
Rate
Account Balance
within 12 mos.
Notes & Accounts Receivable
1
2
3
4
5
6
7

Amount Due
Beyond 12 mos.

TOTALS

Investment in Coops & Retains Receivable

1
2
3
4
5
TOTALS

SCHEDULE 5: CROP AND FEED INVENTORY

Crop and Feed Inventories
Number of
Crop Type/Description
Units
Price Per Unit
Crop Inventory

Total Dollar Value

CCC Loans Outstanding

Units Under
Crop Year
Loan
Loan Payoff Amount

TOTALS

Feed Inventory

First Bank of Berne

Page 2 of 17

TOTALS

First Bank of Berne

Page 3 of 17

SCHEDULE 6: LIVESTOCK INVENTORY

Market Livestock
Number of
Head

Description

Avg $ per
Current
Weight cwt Dollar Value

TOTALS

Breeding Livestock
Description

Number of
Head

Dollars per
Head

Current
Dollar Value

Number of
Head

Dollars per
Head

Current
Dollar Value

TOTALS

Miscellaneous Livestock
Description

TOTALS

SCHEDULE 7: INVESTMENT IN GROWING CROPS/PREPAID EXPENSES/SUPPLIES

Investment in Growing Crops
Prepaid Expenses
# of
$ per
Total
Date
Crop
Expense Description
Description
Acre
Value
Incurred Acres

TOTAL

First Bank of Berne

TOTAL

Supplies
Dollar
Amount

Description

Dollar
Amount

TOTAL

Page 4 of 17

SCHEDULE 8: VEHICLES, MACHINERY & EQUIPMENT

Year

Make

Model

Description

SUBTOTAL

Market
Value

Year

Make

Model

Description

Market Value

SUBTOTAL
TOTAL

First Bank of Berne

Page 5 of 17

SCHEDULE 9: REAL ESTATE

Description

Titled in Names of

Yr.
Acquired

Cost
Basis

Total
Acres

Crop
Acres

Market
$/Acre

Valuation
Est. Market
Est. Market Value
Value of Land
of Improvements

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
TOTALS

Lien Holder (if any)

Date Last
Payment Made

Maturity
Date

Payment
Freq.

Loan
Balance

Interest
Rate

Annual
Pymnt

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

Principal
Payment

Accrued
Interest
-

Princ Due
Beyond 12
m

TOTALS

SCHEDULE 10: ACCOUNTS PAYABLE & CREDIT CARDS

Due to
Purpose
1
2
3
4
5
6
7
8
9
10

Due Date

Amount Due

TOTAL

First Bank of Berne

Page 6 of 17

SCHEDULE 11: NOTES PAYABLE OPERATING

Due to

Maturity
Date

Collateral Description

Interest
Rate Loan Balance

Accrued
Interest

1
2
3
4
TOTAL

SCHEDULE 12: INTERMEDIATE NOTES PAYABLE

Creditor/Collateral
Maturity
Date Last
Description
Date
Payment Made
1
2
3
4
5
6
7
8
9
10

Payment
Freq.

Loan
Balance

Interest
Rate

Annual
Pymnt

Principal
Payment

Accrued
Interest
-

Princ Due
Beyond 12
m

TOTALS

SCHEDULE 13: LEASE ARRANGEMENTS-(EQUIPMENT AND BUILDING)

Maturity
Payment
Payable to & Description
Date
Freq.
Balance
1
2
3
4
5
6
7
8
9
10

Amount Due
within 12 mos

Amount Due
beyond 12 mos

TOTALS

SCHEDULE 14: FARM AND BUSINESS VENTURES

Name of Farm/Business Venture that
Position/Title
you are a Principal or Partner
1
2
3
4
5
6
7

Line of Business

Years in
business Ownership %

Business Net
Worth

Your Present
Value
-

TOTALS

First Bank of Berne

Page 7 of 17

First Bank of Berne

Page 8 of 17

Your DOB

Spouse DOB

Ages of dependents

Farm Insurance Company

Farm Insurance Agent

FARM PLANTING PROGRAM

Number of acres you are farming:

Number of acres owned:

Number of acres cash rented:
Number of acres share rented:

2015 Actual Crop Production

My
Acres

Actual
Yield

Bu
for feed

Actual/
X Expected
Price

Gross
Income

Corn

$0.00

$0

Soybeans

$0.00

$0

Wheat

$0.00

$0

Hay

$0.00

$0

Other

$0.00

$0

Ex. Silage, Oats, etc

$0.00

$0
TOTAL $0

2016 Projected Crop Production

My
Acres

X Expected
Yield

Minus Bu
for feed

X Expected
Price

Gross
Income

Corn

$0.00

$0

Soybeans

$0.00

$0

Wheat

$0.00

$0

Hay

$0.00

$0

Other
Ex. Silage, Oats, etc

$0.00

$0
TOTAL $0

Crop Insurance

Crop Insurance Company:

Policy Type
Coverage %

RP, RPHPE, YP, AYP, ARP,ARPHPE

Corn
Soybeans
Wheat
Hay
Other

Options (RO, HRO,YA)

Hail Coverage $/A

50-90%
0%
0%
0%
0%
0%

0
0
0
0
0

Cash and Share Rental Agreements

Rented Farm: Legal Desc.

Landlord

Type of Lease

Expires

Acres Annual Cash Rent

Estimated Cost per acre - Crop Year 2016

Name:
Your Farm per acre Costs
Corn

Soybeans

Seed
Fertilizer
Chemicals
Dryer Fuel
Machinery Fuel
Machinery Repair
Hauling
Interest
Insurance
Machinery Replacement
Drying & Handling Replacement
Family & Hired Labor
Land Cost

Additional Expenses over whole farm

Storage

Farm Insurance

Fuel & oil

Utilities

Custom Hire

Consultants

Hired Labor

Marketing

Land Rent

Dues & Professional Fees

Machinery Leases

Accounts Payable

Building Leases

Feed Purchases

Livestock Leases

Veterinary, Meds, Breeding Fees

Grazing Fees

Feeder Livestock Purchases

Real Estate Taxes

Personal Property Taxes
Supplies

Wheat

Estimated Crop Income - Crop Year 2016

(Fill out numbers in Yellow to figure your profit per acre)
Name:
INCOME
Corn

Acres
Est. Yield
Price/Bu.
TOTAL

$
$

1
198
3.80
752

$
$

1
60
8.40
504

Est. Yield
Price/Bu.
TOTAL

$
$

1
85
4.80
408

TOTAL INCOME

1,664

SoybeanAcres
Est. Yield
Price/Bu.
TOTAL

Wheat Acres

EXPENSES
Corn
$
$
$
$
$
$
$
$
$
$
$
$
$

158
123
42
46
15
22
19
13
32
98
5
46
269

TOTAL EXPENSES

888

NET INCOME

Fertilizer
Seed
Pesticides
Dryer Fuel
Machinery Fuel
Machinery Repair
Hauling
Interest
Insurance & Misc.
Machinery Replacement
Drying & Handling Replace
Family & Hired Labor
Land Cost

Soybeans
$
63
$
74
$
27
$
$
9
$
18
$
6
$
7
$
23
$
98
$
5
$
46
$
269

Wheat
$
$
$
$
$
$
$
$
$
$
$
$
$

98
44
12
9
18
9
6
3
98
5
46
269

645 $

617

(136) $

(141) $

(209)

TOTAL NET FARM INCOME

(486)

Below are estimated expenses provided by Purdue University for 2016

First Bank of Berne encourages you to use your actual expenses and yields
Please Visit: http://www.agecon.purdue.edu/extension/pubs/id166-w_2015_sept_2014.pdf
for more explaination on estimated expenses
Fertilizer
Seed
Pesticides
Dryer Fuel
Machinery Fuel
Machinery Repair
Hauling
Interest
Insurance & Misc.
Machinery Replacement
Drying & Handling Replace
Family & Hired Labor
Land Cost

158
123
42
46
15
22
19
13
32
98
5
46
269

63
74
27

98
44
12

9
18
6
7
23
98
5
46
269

9
18
9
6
3
98
5
46
269

Planned Capital Asset Purchases and Sales for 2016

Please list projected purchases and sales for projected borrowing needs for 2015.
Machinery, Titled Vehicles, tiling, land, etc
Farm Assets

Estimated Date

Capital Purchases ($)

Capital Sales ($)

Capital Asset Purchases and Sales for 2015

(please list actual purchases and sales in 2015:Machinery, Titled Vehicles, tiling, land, etc)
Farm Assets

Capital Purchases ($)

Capital Sales ($)

Capital Purchases ($)

Capital Sales ($)

Breeding Livestock (Excluding Raised Livestock

Titled Vehicles
Land
Buildings and Improvements
Machinery and Equipment

Personal Assets

Stocks and Bonds

Household Furnishings and Appliances
Personal Vehicles
Cash Value of Life Insurance
Retirement Accounts
Personal Business Investment
Personal Real Estate

Amount ($)
Inheritances, Gifts Received
Captial Distributions, dividends, gifts given
Income and Social Security Tax
Family Living Expense
Nonfarm Income

CASH FLOW-LOAN PROJECTION FOR

CROP YEAR

Enter Beginning Cash Balance

Enter Beginning Operating Loan Balance
TOTAL
Beginning Cash Balance

JAN

FEB

APR

MAY

JUN

JUL

SEP

OCT

MAR
-

AUG
-

NOV
-

DEC
-

INCOME ITEMS

1. Grain Sales - Corn

2. Grain Sales - Soybeans
3. Grain Sales - Wheat & Other
4. Market Hogs & Feeder Pig Sales
5. Cattle Sales
6. Breeding Stock Sales & Culls
7. Milk Sales
8. Machinery, Equipment & Land Sales
9. Custom Work
10. Government Payments
11. Dividends & Patronage Refunds
12. Off-Farm Income
13. Other
14. Other
15. Total Cash Available (Add Lines 1-14) -

EXPENDITURES
16. Labor Hired - Including taxes
17. Fertilizer & Lime
18. Chemicals
19. Seed
20. Custom Hire
21. Supplies
22. Rent - Land
23. Rent & Leases - Machinery & Bldgs.
24. Gas, Oil & Fuel
25. Storage & Custom Drying
26. Feed Purchases
27. Veterinary, Medicine, Breeding Fees
28. Feeder Livestock Purchases
29. Utilities
30. Repairs - Equipment & Buildings
31. Insurance
32. Taxes - Real Estate & Personal Prop.
33. Capital Expenditures - Equip, Bldgs
34. Capital Expenditures - Breeding Stock
35. Hedging Account Deposits
36. Family Living Withdrawals
37. Other
38. Other
39. Total Cash Required (Add Lines 16-38) 40. Cash Position (Line 15 - Line 39)
41. Intermediate & Mortgage New Loans
42. Term & Mtg Loan Principal Payments
43. Term & Mtg Loan Interest Payments
44. Operating Loan Interest
45. Cash Position (40+41-42-43-44)
46. Operating Loan - Draw
47. Operating Loan - Payment
48. Ending Cash Position (45+46-47)
49. Operating Loan Balance

BORRROWERS SIGNATURE AUTHORIZATION

I hereby authorize the Lender to verify my past and present employment earnings, records, bank
accounts, stock holdings and any other asset balances that are needed to process my loan
application.
I further authorize the Lender to order a consumer credit report and verify other credit information,
including past and present mortgage and landlord references.
The information the Lender obtains is only to be used in the processing of my application for a loan.
If I am requesting a loan from Lender to payoff an existing debt with another financial institution, I
hereby authorize Lender to obtain a payoff figure on the existing loan.

Signature:

Date:

Signature:

Date: