BALANCE SHEET MO. DAY YEAR STATEMENT OF AS OF / / TO First National Bank in Olney Co mract!sl Notes Rte Amounts F rom S chedule at 3 S HOW TOTAL ABOVE Amounts From Schedule at 6 Are you obl11ated to pay ali mony, 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 C on1racl 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 F rom Schedule at 4 4. CURRENT LIABILITIES Subtotal Debts due in more than l and le ss I.T. LIABILITIES than 10 yrs. (less current amounts) Secu1ed 8y R ate SHOW TOTAL ABOVE lllelns. LOins Amo unts F rom Schedule at 5 5. INTERMEDIATE TERM LIABILITIES Subtotal LONG TERM LIABILITIES %" ~. a;:: :::.. "'!"-.," Owed Secured To 8-,I Ac,es Rate E 1pt ainanyYESanswers - - - ---- - -------- - -- - - --- - -- - -------------- - - -- -- !Continue on A ttachment! 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. S IGNED I I ON SIGNA TURE S IGNAIURE