Fillable CONTENTS OF FARM OWNERSHIP LOANS (USDA)

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CONTENTS OF FARM OWNERSHIP LOANS (USDA)

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CONTENTS OF FARM OWNERSHIP LOANS
- FSA-2001, Request for Direct Loan Assistance
- FSA-2002, Three-Year Financial History
- FSA-2003, Three-Year Production History
- FSA-2004, Authorization to Release Information
- FSA-2005, Creditor List
- FSA-2006, Property Owned and Leased
- FSA-2037, Farm Business Plan Worksheet – Balance Sheet
- FSA-2038, Farm Business Plan Worksheet - Farm Business Plan Worksheet
- FSA-2302, Description of Farm Training and Experience
This form is available electronically.
Form Approved
–
OMB No. 0560
-
0237
FSA-2001
(03-06-15)
U.S. DEPARTMENT OF AGRICULTURE
Farm Service Agency
Position 3
REQUEST FOR DIRECT LOAN ASSISTANCE
INSTRUCTIONS: FSA suggests applicants use the available corresponding instructions found on the internet at
http://tinyurl.com/kwm5rem for the proper completion of this form. Assistance is also available from local FSA offices for any part of the
application process. FSA can provide assistance in completing requested forms, explain what information is necessary, and answer any
questions regarding the application process.
Farm Loan Teams located at USDA Service Centers or FSA County Offices are responsible for all direct loan applications. You can find
the address and telephone number of the nearest Farm Loan Team serving the County where you plan to farm from the Internet at
http://tinyurl.com/7syle36.
The Federal Government requests race, ethnicity and gender information to monitor FSA’s compliance with Federal laws prohibiting
discrimination against applicants. Applicants are encouraged to furnish this information. This information is not used to evaluate an
application and choosing not to provide this information will not affect the application process.
Targeted funding is available to any member of a targeted underserved group. Targeted underserved groups include American Indians
or Alaskan Natives, Asians, Blacks or African Americans, Native Hawaiians or other Pacific Islanders, Hispanics, and Women. Targeted
funding may not be received if an applicant fails to voluntarily provide race, ethnicity and gender information.
IMPORTANT NOTICE
Within 10 calendars days of the date FSA receives your application, FSA will send you
a letter that will tell you if your application is complete, or additional information is
needed to complete your loan application. Incomplete applications cannot be
processed. If you do not receive this letter within 10 days of the submission of your
application, please contact your local FSA office.
APPLICANT IDENTIFICATION
The l oan application must be submitted in the name of the ACTUAL OPERATOR of the farm or ranch.
An individual who operates as a legal entity, or two or more applicants operating and applying jointly, are considered an ENTITY
applicant.
Married persons are considered joint operations if the day-to-day management and operation responsibilities of the farm enterprise are
shared. Married couples who wish to apply together and have not formed an operating entity such as a partnership, LLC, trust or
corporation, are to proceed as designated below. Married couples who have formed a legal entity as part of the farm or ranch should
complete this application as an entity applicant.
The Applicant is a/an:
• Individual, Not Married, Not Operating as a Legal Entity. BEGIN at PART A.
• Individual, Operating as a Legal Entity. BEGIN at PART C.
• Married Couple, One Spouse Applying. BEGIN at PART A.
• Married Couple, Applying Jointly, Not a Legal Entity. BEGIN at PART B.
• Joint Operation, Two or More Persons, Not Married, Not a Legal Entity. BEGIN at PART C.
• Entity Applicant. BEGIN at PART C.
NOTE: Entity Applicants are required to provide supporting documentation such as, and not necessarily limited to, Articles of
Incorporation; Articles of Organization; Certificate of Limited Partnership; Formal Partnership Agreement; By-Laws and
Operational Authorities of all shareholders, members and owners to verify the legal status of the entity, the authority of the
shareholders, members or owners, and the composition of the entity structure(s).
PLEASE KEEP THIS PAGE FOR YOUR RECORDS
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This form is available electronically.
Form Approved
–
OMB No. 0560
-
0237
FSA-2001
(03-06-15)
U.S. DEPARTMENT OF AGRICULTURE
Farm Service Agency
Position 3
REQUEST FOR DIRECT LOAN ASSISTANCE
PART A – INDIVIDUAL APPLICANT, NOT A LEGAL ENTITY
Instructions: Individual applicants and married applicants with a non-applicant spouse will complete Items 1 through 16. Items 1 1, 14
and 15 are voluntary. *Race, ethnicity, and gender information is requested by the Federal Government to monitor FSA's compliance
with Federal laws prohibiting discrimination against applicants. Applicants are not required to furnish this information but are
encouraged to do so. Failure to provide this information may result in not receiving targeted funds for which the applicant may be
eligible. This information will not be used to evaluate this application.
1. Exact Full Legal Name
2. Email Address
3. Mailing Address
(Including Zip Code)
4A. Physical Address
(If different than mailing address)
4B. County of Residence
Same as Physical Address: YES NO
5
. Contact Telephone Numbers
(Area Code)
:
6. County of Operation Headquarters
7. Date of Birth
(MM
-
DD
-
YYYY)
Home:
Primary
Cell:
Primary
8. Social Security Number
(9 digits)
Business:
Primary
9
. Name and Address of Employer
(If applicable)
1
0
. Applicant Is:
*1
1
. Race:
U.S. Citizen American Indian/Alaskan Native
*Non-Citizen National Asian
*Resident Alien (I-551) Black/African American
*Refugee or Other
Native Hawaiian/Other Pacific
Islander
*NOTE: Applicant will be asked to provide
I-551 and/ or other proper documentation of
immigration status as found under PRWORA
(8 U.S.C. 1641).
White
Telephone Number (Area Code): NOTE: More than one box may be selected.
12. Veteran Status 13. Marital Status *14. Applicant Is: *15. Gender 16. FSA Use Only
Veteran Unmarried Divorced Hispanic or Latino Male Observed
Not Veteran Separated Legally Separated Not Hispanic or Latino Female Provided
Married, Applying as Individual
PROCEED TO PART D
NOTE:
The following statement is made in accordance with the Privacy Act of 1974 (5 USC 552a – as amended). The authority for requesting the information identified on
this form is 7 CFR Part 761, 7 CFR Part 764, the Consolidated Farm and Rural Development Act (7 U.S.C. 1921 et seq.), and the Agricultural Act of 2014 (Pub. L.
113-79). The information will be used to determine eligibility to participate in and receive benefits under the Direct Loan Program. The information collected on this
form may be disclosed to other Federal, State, Local government agencies, Tribal agencies, and nongovernmental entities that have been authorized access to the
information by statute or regulation and/or as described in applicable Routine Uses identified in the System of Records Notice for USDA/FSA-14,
Applicant/Borrower. Providing the requested information is voluntary. However, failure to furnish the requested information will result in a determination of
ineligibility to participate in and receive benefits under the Direct Loan Program.
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information
unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0560-0237. The time required to complete this
information collection is estimated to average 33 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information. RETURN THIS COMPLETED FORM TO YOUR COUNTY FSA OFFICE.
The U.S. Department of Agriculture (USDA) prohibits discrimination against its customers, employees, and applicants for employment on the basis of race, color, national origin, age, disability, sex, gender
identity, religion, reprisal, and where applicable, political beliefs, marital status, familial or parental status, sexual orientation, or all or part of an individual’s income is derived from any public assistance
program, or protected genetic information in employment or in any program or activity conducted or funded by the Department. (Not all prohibited bases will apply to all programs and/or employment
activities.) Persons with disabilities, who wish to file a program complaint, write to the address below or if you require alternative means of communication for program information (e.g., Braille, large print,
audiotape, etc.) please contact USDA’s TARGET Center at (202) 720-2600 (voice and TDD). Individuals who are deaf, hard of hearing, or have speech disabilities and wish to file either an EEO or
program complaint, please contact USDA through the Federal Relay Service at (800) 877-8339 or (800) 845-6136 (in Spanish).
If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online at http://www.ascr.usda.gov/complaint_filing_cust.html,
or at any USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter by mail to
U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, by fax (202) 690-7442 or email at program.intake@usda.gov. USDA
is an equal opportunity provider and employer.
Initials:
Date:
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FSA
-
2001
(03-06-15) Page 2 of 8
PART B – MARRIED COUPLE, APPLYING JOINTLY, NOT A LEGAL ENTITY
Instructions: Married couples who are joint operators of the operation, are applying jointly, and who have not formed a legal entity will
complete the sections below. Items 7, 10 and 11 are voluntary. The other spouse will complete Items 13 through 23; Items 19, 22
and 23 are voluntary. Items 25 through 29 pertain to both applicants jointly.
1. Exact Full Legal Name
2. Email Address
3. Social Security Number
(9 digits)
4. Date of Birth
(MM
-
DD
-
YYYY)
5
. Contact Telephone Numbers
(Area Code)
:
Home: Primary
6. Applicant Is:
*7. Race:
Cell: Primary
U.S. Citizen American Indian/Alaskan Native
Business: Primary
*Non-Citizen National Asian
8. Name and Address of Employer
(If applicable)
*Resident Alien (I-551) Black/African American
*Refugee or Other Native Hawaiian/Other Pacific Islander
*NOTE: Applicant will be asked to provide
I-551and/ or other proper documentation of
immigration status as found under PRWORA
(8 U.S.C. 1641).
White
NOTE: More than one box may be selected.
Telephone Number (Area Code):
9
. Veteran Status
*10. Applicant Is
*11. Gender
12. FSA Use Only
Veteran Hispanic or Latino Male Observed
Not Veteran Not Hispanic or Latino Female Provided
13. Exact Full Legal Name
14. Email Address
15. Social Security Number
(9 digits)
16. Date of Birth
(MM
-
DD
-
YYYY)
17
. Contact Telephone Numbers
(Area Code)
:
Home: Primary
18. Applicant Is:
*19. Race:
Cell: Primary
U.S. Citizen American Indian/Alaskan Native
Business: Primary
*Non-Citizen National Asian
20. Name and Address of Employer
(If applicable)
*Resident Alien (I-551) Black/African American
*Refugee or Other Native Hawaiian/Other Pacific Islander
*NOTE: Applicant will be asked to provide
I-551and/ or other proper documentation of
immigration status as found under PRWORA
( 8 U.S.C. 1641).
White
NOTE: More than one box may be selected.
Telephone Number (Area Code):
21.
Veteran Status
*22. Applicant Is
:
*23. Gender
24. FSA Use Only
Veteran Hispanic or Latino Male Observed
Not Veteran Not Hispanic or Latino Female Provided
2
5
.
Mailing Address
(Including Zip Code)
26
. Physical Address
(If different than mailing
address)
Same as Physical Address: YES NO
27. County of Operation Headquarters
28. County of Residence
PROCEED TO PART D
Initials:
Date:
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FSA
-
2001
(03-06-15) Page 3 of 8
PART C – ENTITYAPPLICANT
Instructions: An entity is a corporation, formal, joint operation, Limited Liability Corporation, Trust or other legal business organization
comprised of 1 or more individuals which may or may not have an entity name or entity tax identification number. Organizations
operating as non-profit entities and Estates are not considered eligible entities for Farm Loan Program purposes. Informal entities may
leave Items 3 through 8 blank. Items 22, 25 and 26 are voluntary. All other information must be provided on each entity associated
with the operation and each individual member of the associated entity. NOTE: Individual liability is required regardless of entity
type.
1. Full Entity or Trust Name
2. Entity Address
(Including Zip Code)
3
. Entity Type:
Corporation
S Corp
4
. Entity Contact Telephone Number
5
. State of Registration/Corporation
C Corp
Limited Liability Company
6. Registration
ID
Number
7. Date of Formation
(MM
-
DD
-
YYYY)
Joint Operation
Formal Partnership
8. Tax Identificatio
n Number
(9 digits)
9
. County of Operation Headquarters
Revocable Trust
Irrevocable Trust
10
. Does Entity Contain Embedded Entity
?
Cooperative
YES, (Complete Items 11, 12, and 13 for each entity)
Life Estate
NO, (Proceed to Item 14) Other:
11. List all Embedded Entities
1
2
. Percentage of Interest
1
3
. Number of Entity Members
%
NOTE: Items 14 through 28 pertain to individual members of the entity, or in the case of partnerships and joint operations , each
co-applicant. Every member of the entity must complete Items 14 through 28. If farm operation operates with more than 1 entity,
each entity and all its members must provide this information. This application provides for the entry of 1 entity and 3 entity members.
Please make copies of this section, as necessary. Items 21, 24 and 25 are voluntary.
14. Exact Full Legal
ame of Entity Member
15. Percentage o
f Interest
16. Email Address
%
17. Social Security Number
(9 digits)
18. Date of Birth
(MM
-
DD
-
YYYY)
19
. Contact Telephone Numbers
(Area Code)
:
Home: Primary
20. Applicant Is:
*21. Race
Cell: Primary
U.S. Citizen American Indian/Alaskan Native
Business: Primary
*Non-Citizen National Asian
22. Name and Address of Employer (If applicable)
*Resident Alien (I-551) Black/African American
*Refugee or Other Native Hawaiian/Other Pacific Islander
*NOTE: Applicant will be asked to provide
I-551 and/ or other proper documentation of
immigration status as found under PRWORA
(8 U.S.C. 1641)
White
NOTE: More than one box may be selected.
Telephone Number (Area Code):
2
3
.
Veteran Status
*24. Applicant Is
*25. Gender
26. FSA Use Only
Veteran Hispanic or Latino Male Observed
Not Veteran Not Hispanic or Latino Female Provided
2
7
.
Mailing Address
(Including Zip Code)
28A
. Physical Address
(If different than mailing
address)
28B. County of Residence
Same as Physical Address: YES NO
Initials:
Date:
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FSA
-
2001
(03-06-15) Page 4 of 8
PART
C
–
ENTITY
APPLICANT
(
Continued
)
14. Exact
Full Legal name of Entity Member
15. Percentage of Interest
16. Email Address
%
17. Social Security Number
(9 digits)
18. Date of Birth
(MM
-
DD
-
YYYY)
19
. Contact Telephone Numbers
(Area Code)
:
Home: Primary
20. Applicant Is:
*21. Race
Cell: Primary
U.S. Citizen American Indian/Alaskan Native
Business: Primary
*Non-Citizen National Asian
22. Name and Address of Employer
(If applicable)
*Resident Alien (I-551) Black/African American
*Refugee or Other Native Hawaiian/Other Pacific Islander
*NOTE
: Applicant will be asked to provide
I-551 and/ or other proper documentation of
immigration status
as found under PRWORA
(8 U.S.C. 1641)
White
NOTE: More than one box may be selected.
Telephone Number (Area Code):
2
3
.
Veteran Status
*24. Applicant Is
*25. Gender
26. FSA Use Only
Veteran Hispanic or Latino Male Observed
Not Veteran Not Hispanic or Latino Female Provided
2
7
.
Mailing Address
(Including Zip Code)
28A
. Physical Address
(If different than mailing address)
28B. County of Residence
Same as Physical Address: YES NO
14. Exact Full
Legal name of Entity Member
15. Percentage of Interest
16. Email Address
%
17. Social Security Number
(9 digits)
18. Date of Birth
(MM
-
DD
-
YYYY)
19
. Contact Telephone Numbers
(Area Code)
:
Home: Primary
20. Applicant Is:
*21. Race
Cell: Primary
U.S. Citizen American Indian/Alaskan Native
Business: Primary
*Non-Citizen National Asian
22. Name and Address of Employer (If applicable)
*Resident Alien (I-551) Black/African American
*Refugee or Other Native Hawaiian/Other Pacific Islander
*NOTE
: Applicant will be asked to provide
I-551 and/ or other proper documentation of
immigration status
as found under PRWORA
(8 U.S.C. 1641)
White
NOTE: More than one box may be selected.
Telephone Number (Area Code):
2
3
.
Veteran Status
*24. Applicant Is
*25. Gender
26. FSA Use Only
Veteran Hispanic or Latino Male Observed
Not Veteran Not Hispanic or Latino Female Provided
2
7
.
Mailing Address
(Including Zip Code)
28A
. Physical Address
(If different than mailing address)
28B. County of Residence
Same as Physical Address: YES NO
PROCEED TO PART D
Initials:
Date:
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FSA
-
2001
(03-06-15) Page 5 of 8
PART D – GENERAL INFORMATION
1.
Counties Being Farmed
2. Acres Owned
3. Acres Rented
4A. Purpose of Loan
4B. Amount Requested
$
5A. Purpose of Loan
5B. Amount Requested
$
6. Description of Operation
PROCEED TO PART E
PART E – NOTIFICATIONS, CERTIFICATIONS AND ACKNOWLEDGMENT
YES NO
1.
Are you currently or have you ever, and in the case of an entity any member of the entity, conducted
business under any other name? If "YES," list names in Item 9.
2.
Have you ever, or in the case of an
entity any member of the entity, obtained a direct or guaranteed farm
loan from FSA or Farmers Home Administration?
3.
If Item 2 is "YES," did you receive any debt forgiveness through write
-
down, write
-
off, compromise,
adjustment, reduction, charge-off, paying a loss on a guarantee, or bankruptcy? If "YES," provide details in
Item 9.
4.
Are you, or in the case of an entity any member of the entity, delinquent on any Federal debt or have any
outstanding Federal judgments? If "YES," provide details in Item 9.
5.
Are you, or in the case of an entity any member of the entity, involved in any pending litigation? If "YES,"
provide details in Item 9.
6.
Have you, or in the case of an entity any member of the entity, ever been in receivership, discharged in
bankruptcy, or filed a petition for reorganization in bankruptcy? If "YES," provide details in Item 9.
7.
Are you, or in the case of an entity any member of the entity, an FSA employee or related to or closely
associated with an FSA employee? If "YES," provide details in Item 9.
8.
Are you now or have you ever, operated a
farm? If "YES," provide number of years and details in Item 9.
9.
Additional answers. Write the Item
number to which each answer applies. If you need additional space, use sheets of paper the
same size as this page and write the applicant's name on each additional sheet.
Initials: Date:
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FSA- 2001 (03-06-15)
Page 6 of 8
PART E – NOTIFICATIONS, CERTIFICATIONS AND ACKNOWLEDGMENT (Continued)
10. SPECIAL PROGRAM INFORMATION.
Certain FSA programs are, by law, designed to reach targeted applicants. If you are interested in any of the programs described
here, or have questions about these programs and whether you may qualify for a specific program, the FSA office processing
your application will help you.
A. S OCIALLY DISADVANTAGED APPLICANTS : A portion of FSA farm ownership , operating, and conservation
loan funds are, by law, targeted to applicants who have been subjected to racial, ethnic or gender prejudice because of
their identity as a member of a group, without regard to individual qualities. Under the applicable law, groups meeting
this condition are: American Indians/Alaskan Natives, Asians, Blacks or African Americans, Native Hawaiians/Other
Pacific Islanders, Hispanics and women. In addition, FSA h as a down payment program, which receives special
funding.
B. BEGINNING FARMER ASSISTANCE: FSA has the authority to assist beginning farmers through the farm
ownership , operating, and conservation loan programs. A portion of FSA farm ownership , operating, and conservation
loan funds are, by law, targeted to beginning farmers. In addition, FSA has a down payment program, which receives
special funding. In some States, FSA has agreements with State beginning farmer programs to help meet the credit
needs of beginning farmers.
C. LIMITED RESOURCE LOANS: Limited resource farm ownership and operating loans are available to qualified
applicants. This program provides loans at reduced interest rates to low- income farmers whose operations and
resources are so limited that they cannot pay the regular rates for FSA loans. The program is also intended to provide
beginning farmers the opportunity to start a successful farming operation.
11. RIGHTS AND POLICIES.
A. RIGHT TO FINANCIAL PRIVACY ACT OF 1978 (Public Law 95-630): FSA has a right of access to financial
records held by financial institutions in connection with providing assistance to you as well as collecting on loans made
to you or guaranteed by the Government. Financial records involving your transaction will be available to FSA without
further notice or authorization but will not be disclosed or released by this institution to another Government Agency or
Department without your consent except as required by law.
B. THE FEDERAL EQUAL CREDIT OPPORTUNITY ACT: Prohibits creditors from discriminating against
applicants on the basis of race, color, religion, sex, national origin, marital status, age (provided the applicant has the
capacity to enter into a binding contract), because all or a part of the applicant's income derives from any public
assistance program, or because the applicant has in good faith exercised any right under the Consumer Credit Protection
Act.
C. FEDERAL COLLECTION POLICIES: Delinquencies, defaults, foreclosures and abuses of loans involving
programs of the Federal Government can be costly and detrimental to your credit, now and in the future. The lender in
this transaction, its agents and assigns as well as the Federal Government, its agencies, agents and assigns, are
authorized t o take any and all of the following actions in the event loan payments become delinquent: (1) Report your
name and account information to a credit bureau; (2) Assess additional interest and penalty charges for the period of
time that payment is not made; (3) Assess charges to cover additional administrative costs incurred by the Government
to service your account; (4) Offset amounts owed to you under other Federal programs; (5) Refer your account to a
private attorney, collection agency or mortgage servicing agency to collect the amount due, foreclose the mortgage, sell
the property and seek judgment against you for any deficiency; (6) Refer your account to the Department of Justice for
litigation; (7) Take action to offset your salary, or retirement benefits; (8) Refer your debt to the Department of the
Treasury for cross-servicing and offset against any amount owed to you by any Federal Agency such as an income tax
refund; and (9) Report any resulting written-off debt to the Internal Revenue Service as taxable income. All of these
actions can and will be used to recover debts owed to the Federal Government when in its best interests.
12. RESTRICTIONS AND DISCLOSURE OF LOBBYING ACTIVITIES:
A. The applicant:
(1) Certifies that if any funds, by or on behalf of the applicant, have been or will be paid to any person for
influencing or attempting to influence an officer or employee of any agency, a Member, an officer or employee
of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract,
the making of any Federal grant or Federal loan, and the extension, continuation, renewal, amendment, or
modification of any Federal contract, grant, or loan, the applicant shall complete and submit Standard Form -
LLL, "Dis closure of Lobbying Activities," in accordance with its instructions.
Initials: Date:
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FSA- 2001 (03-06-15)
Page 7 of 8
PART E – NOTIFICATIONS, CERTIFICATIONS AND ACKNOWLEDGMENT (Continued)
RESTRICTIONS AND DISCLOSURE OF LOBBYING ACTIVITIES: (CONTINUED)
(2) Shall require that the language of this certification be included in the award documents for all sub-awards at all
tiers (including contracts, subcontracts, and subgrants, under grants and loans) and that all subrecipients shall
certify and disclose accordingly.
B. This certification is a material representation of fact upon which reliance was placed when this transaction was made or
entered into. Submission of this statement is a prerequisite for making or entering into this transaction. Any person
who fails to file the required statement shall be subject to a civil penalty imposed by 31 U.S.C. 1352.
13. CONTROLLED SUBSTANCES:
The applicant certifies that as an individual, or any member of an entity applicant, has not been convicted under Federal or
State law of planting, cultivating, growing, producing, harvesting, or storing a controlled substance within the previous 5 crop
years. See the Food Security Act of 1985 (Public Law 99 -198). The applicant also certifies that as an individual, or any
member of an entity applicant, is not ineligible for Federal benefits based on a conviction for the distribution of controlle d
substances or any offense involving the possession of a controlled substance under 21 U.S.C. § 862.
14. DISQUALIFICATION DUE TO FEDERAL CROP INSURANCE FRAUD:
The applicant certifies that as an individual or any member of the entity, has not been disqualified for Federal benefits as
provided in Section 515(h) of the Federal Crop Insurance Act (FCIA). Applicants who willfully and intentionally provide fals e
or inaccurate information to the Federal Crop Insurance Corporation (FCIC) or to an approved insurance p rovider with respect
to a policy or plan of FCIC insurance, after notice and an opportunity for a hearing on the record, will be subject to one or
more of the sanctions described in section 515(h)(3) of FCIA.
15. TEST FOR CREDIT:
The applicant certifies that the needed credit, with or without a loan guarantee, cannot be obtained by (1) the individual
applicant; (2) in the case of an entity, considering all assets owned by the entity and all of the individual members. The
provisions of this para graph do not apply if the request is for a Conservation Loan.
16. PERMISSION TO FILE FINANCING STATEMENT:
Under the Uniform Commercial Code, you do not have to sign the financing statement which allows FSA to obtain a security
interest in your property. If the loan is approved and funded, FSA will file a financing statement at the earliest possible date,
befo re you enter into a SECURITY AGREEMENT. BY SIGNING BELOW, I GIVE FSA PERMISSION TO FILE A
FINANCING STATEMENT PRIOR TO THE EXECUTION OF THE SECURITY AGREEMENT AS WELL AS TO
FILE AMENDMENTS AND CONTINUATIONS OF THE FINANCING STATEMENT THEREAFTER.
PROCEED TO PART F
Initials: Date:
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FSA- 2001 (03-06-15)
Page 8 of 8
PART F – CERTIFICATION AND SIGNATURES
CERTIFICATION:
I certify that the information
provided is true, complete, and correct to the best of my knowledge and is
provided in good faith to obtain a loan. (WARNING: Section 1001 of Title 18, United States Code, provides for criminal pena lties
to those who provide false statements to the Government. If any information is found to be false or incomplete, such finding may be
grounds for denial of the requested action).
1A. Signature of Individual Applicant, Spouse or Entity Member
1B. Capacity
1C. Date Signed
(MM
-
DD
-
YYYY)
Self
Entity Representative
2A. Signature of Individual Applicant, Spouse or Entity Member
2B. Capacity
2C. Date Signed
(MM
-
DD
-
YYYY)
Self
Entity Representative
3A. Signature of Individual Applicant, Spouse or Entity Member
3B. Capacity
3C. Date Signed
(MM
-
DD
-
YYYY)
Self
Entity Representative
4A. Signature of Individual Applicant, Spouse or Entity Member
4B. Capacity
4C. Date Signed
(MM
-
DD
-
YYYY)
Self
Entity Representative
5A. Signature of Individual Applicant, Spouse or Entity Member
5B. Capacity
5C. Date Signed
(MM
-
DD
-
YYYY)
Self
Entity Representative
6
A. Signature of Individual Applicant, Spouse or Entity Member
6
B. Capacity
6
C. Date Signed
(MM
-
DD
-
YYYY)
Self
Entity Representative
PART G– FSA USE ONLY
1. Date FSA
-
2001 Received
2. Date Application Complete
3
A
. Amount of Credit Report
Fee Received
3B.
Date
Credit Report
Fee Received
$
4. Type of Assistance Requested
:
5. Name of A
gency Official Receiving Application
FO OL Primary Loan Servicing
EM CL Subordination
Other (Specify):
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Form Approved – OMB No. 0560-0237
This form is available electronically. (See Page 2 for Privacy Act and Paperwork Reduction Act Statements)
FSA-2002
U.S. DEPARTMENT OF AGRICULTURE
Position 3
(08-20-14) Farm Service Agency
THREE-YEAR FINANCIAL HISTORY
1. Name
FORM IS NOT REQUIRED. Applicant may submit alternate documents
that provide the information collected on this form.
A. OPERATING INCOME
20 20 20
1. Crop Sales
2. Livestock & Poultry Sales
3. Dairy Livestock Sales
4. Milk Sales
5. Livestock Product Sales
6. Ag. Program Payments
7. Crop Insurance Proceeds
8. Custom Hire Income
9. Other Income
10. TOTAL OPERATING INCOME
B. OPERATING EXPENSES
1. Car and Truck
2. Chemicals
3. Conservation
4. Custom Hire
5. Depreciation
6. Feed Supplement
7. Feed, Grain and Roughage
8. Fertilizers and Lime
9. Freight and Trucking
10. Gas/Fuel/Oil
11. Insurance
12. Labor Hired
13. Rent - Machinery/Equipment/Vehicle
14. Rent - Land/Animals
15. Repairs and Maintenance
16. Seeds and Plants
17. Supplies
18. Taxes - Real Estate
19. Utilities
20. Veterinary/Breeding/Medicine
21. Purchases for Resale
22. Other Expenses
23. Other - Irrigation
24. Interest
25. TOTAL OPERATING EXPENSES
The U.S. Department of Agriculture (USDA) prohibits discrimination against its customers, employees, and applicants for employment on the basis of race, color, national origin, age, disability, sex, gender identity,
religion, reprisal, and where applicable, political beliefs, marital status, familial or parental status, sexual orientation, or all or part of an individual’s income is derived from any public assistance program, or
protected genetic infor mation in employment or in any program or activity conducted or funded by the Department. (Not all prohibited bases will apply to all programs and/or employment activities.) Persons with
disabilities, who wish to file a program complaint, write to the address below or if you require alternative means of communication for program information (e.g., Braille, large print, audiotape, etc.) please contact
USDA’s TARGET Center at (202) 720-2600 (voice and TDD). Individuals who are deaf, hard of hearing, or have speech disabilities and wish to file either an EEO or program complaint, please contact USDA
through the Federal Relay Service at (800) 877-8339 or (800) 845-6136 (in Spanish).
If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online at http://www.ascr.usda.gov/complaint_filing_cust.html, or at any
USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter by mail to U.S. Department
of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, by fax (202) 690-7442 or email at program.intake@usda.gov. USDA is an equal opportunity
provider and employer.
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FSA-2002 (08-20-14) Page 2 of 2
C. NON-OPERATING
20 20 20
1. Owner Withdrawal
(Total Family Living Expenses
and Non-Farm Debt Payments)
2. Income Taxes
3. Non-Farm Income
4. Non-Farm Expense
D. FINANCING
1. Term Principal Payment
2. Operating Loan Advance
3. Term Loan Advance
4. Operating Loan Payment
E. CAPITAL
1. Capital Sales
2. Capital Contributions
3. Capital Expenditures
4. Capital Withdrawals
F. SIGNATURE
I certify that the information is true, complete, and correct to the best of my knowledge and is provided in good faith.
Warning: Section 1001 of Title 18, United States Code, provides for criminal penalties to those who provide false statements.
If any information is found to be false or incomplete, such finding may be grounds for denial of the requested action.)
1. Signature 2. Date
NOTE:
The following statement is made in accordance with the Privacy Act of 1974 (5 U.S.C. 552a - as amended). The authority for requesting the
information identified on this form is the Consolidated Farm and Rural Development Act, as amended (7 U.S.C. 1921 et. seq.). The information will
be used to determine eligibility and feasibility for loans and loan guarantees, and servicing of loans and loan guarantees. The information collected
on this form may be disclosed to other Federal, State, and local government agencies, Tribal agencies, and nongovernmental entities that have been
authorized access to the information by statute or regulation and/or as described in the applicable Routine Uses identified in the System of Records
Notice for USDA/FSA-14, Applicant/Borrower. Providing the requested information is voluntary. However, failure to furnish the requested information
may result in a denial for loans and loan guarantees, and servicing of loans and loan guarantees. The provisions of criminal and civil fraud, privacy,
and other statutes may be applicable to the information provided.
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0560-0327. The time
required to complete this information collection is estimated to average 45 minutes per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.
RETURN THIS COMPLETED FORM TO YOUR COUNTY FSA OFFICE.
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This form is available electronically. Form Approved –OMB No. 0560-0237
FSA
-
2003
U.S. DEPARTMENT OF AGRICULTURE Position 3
(03-31-10) Farm Service Agency
THREE-YEAR PRODUCTION HISTORY
1. Name
FORM IS NOT REQUIRED. Applicant may submit alternate documents
that provide the information collected on this form.
A. DAIRY PRODUCTION
1. DAIRY COWS 20 20 20
a. Herd Number
b. Lbs. of Milk Sold
c. Average Production Per Cow
d. Calves Sold
e. Calves Average Sale Weight
f. Number of Cows Culled
B. LIVESTOCK AND POULTRY PRODUCTION
1. Livestock Type:
a. Units Raised
b. Units Purchased
c. Total Units
d. Units Sold
e. Death Loss
f. Purchase Weight
g. Sales Weight
2. Livestock Type:
a. Units Raised
b. Units Purchased
c. Total Units
d. Units Sold
e. Death Loss
f. Purchase Weight
g. Sales Weight
3. Livestock Type:
a. Units Raised
b. Units Purchased
c. Total Units
d. Units Sold
e. Death Loss
f. Purchase Weight
g. Sales Weight
NOTE:
The following statement is made in accordance with the Privacy Act of 1974 (5 U.S.C. 552a
-
as amended). The authority for requesting the information identified on this
form is the Consolidated Farm and Rural Development Act, as amended (7 U.S.C. 1921 et. seq.). The information will be used to determine eligibility and feasibility for
loans and loan guarantees, and servicing of loans and loan guarantees. The information collected on this form may be disclosed to other Federal, State, and local
government agencies, Tribal agencies, and nongovernmental entities that have been authorized access to the information by statute or regulation and/or as described in
the applicable Routine Uses identified in the System of Records Notice for USDA/FSA-14, Applicant/Borrower. Providing the requested information is voluntary.
However, failure to furnish the requested information may result in a denial for loans and loan guarantees, and servicing of loans and loan guarantees. The provisions of
criminal and civil fraud, privacy, and other statutes may be applicable to the information provided.
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless
it displays a valid OMB control number. The valid OMB control number for this information collection is 0560-0237. The time required to complete this information
collection is estimated to average 45 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the
data needed, and completing and reviewing the collection of information. RETURN THIS COMPLETED FORM TO YOUR COUNTY FSA OFFICE.
The U.S. Department of Agriculture (USDA) prohibits discrimination in all of its programs and activities on the basis of race, color, national origin, age, disability, and where applicable,
sex, marital status, familial status, parental status, religion, sexual orientation, political beliefs, genetic information, reprisal, or because all or part of an individual’s income is derived
from any public assistance program. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program
information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at (202) 720-2600 (voice and TDD). To file a complaint of discrimination, write to USDA,
Assistant Secretary for Civil Rights, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, S.W., Stop 9410, Washington, DC 20250-9410, or call toll-free at
(866) 632-9992 (English) or (800) 877-8339 (TDD) or (866) 377-8642 (English Federal-relay) or (800) 845-6136 (Spanish Federal-relay). USDA is an equal opportunity provider and
employer.
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FSA-2003 (03-31-10) Page 2 of 2
C. CROP PRODUCTION
20 20 20
1. Crop Unit
a. Total Yield
b. Acres
c. Average Yield
2. Crop Unit
a. Total Yield
b. Acres
c. Average Yield
3. Crop Unit
a. Total Yield
b. Acres
c. Average Yield
4. Crop Unit
a. Total Yield
b. Acres
c. Average Yield
5. Crop Unit
a. Total Yield
b. Acres
c. Average Yield
6. Crop Unit
a. Total Yield
b. Acres
c. Average Yield
7. Crop Unit
a. Total Yield
b. Acres
c. Average Yield
8. Crop Unit
a. Total Yield
b. Acres
c. Average Yield
9. Crop Unit
a. Total Yield
b. Acres
c. Average Yield
D. SIGNATURE
I certify that the information is true, complete, and correct to the best of my knowledge and is provided in good faith. (Warning: Section 1001 of Title 18, United States Code,
provides for criminal penalties to those who provide false statements. If any information is found to be false or incomplete, such finding may be grounds for denial of the
requested action.)
1. Signature 2. Date
Back to top Home
This form is available electronically. Form Approved –OMB No. 0560-0237
FSA-2004
(03-23-10)
U. S. DEPARTMENT OF AGRICULTURE
Farm Service Agency
Position 3
AUTHORIZATION TO RELEASE INFORMATION
As part of considering a loan or servicing request, the Farm Service Agency (FSA), USDA, may verify information
contained in the application and other documents required in connection with the request.
I authorize you to provide to FSA for verification purposes the following applicable information.
(1) Employment or income records.
(2) Bank accounts, stock holdings, and any other assets.
(3) Other credit references.
(4) Debt and collateral information.
I further authorize FSA to order a credit report and verify any other credit information.
I understand that under the Right to Financial Privacy Act of 1978, 12 U.S.C. 3401, et seq., FSA is authorized to access
my financial records held by financial institutions in connection with the consideration or administration of the loan. I
also understand that financial records involving the loan and loan application will be available to FSA without
further notice or authorization, but will not be disclosed or released by FSA to another Government agency or
department or used for another purpose without my consent except as required or permitted by law.
The information FSA obtains is only to be used to process the request for a loan or servicing assistance. A copy or
facsimile of this authorization may be accepted as an original.
Your prompt reply is appreciated.
5A. Name 5B. Signature 5C. Date (MM-DD-YYYY)
Note: The following is made in accordance with the Privacy Act of 1974 (5 USC 552a –as amended). The authority for
requesting the information identified on this form is the Consolidated Farm and Rural Development Act, as amended (7
U.S.C. 1921 et. seq.). The information will be used to determine eligibility and feasibility for loans and loan guarantees, and
servicing of loans and loan guarantees. The information collected on this form may be disclosed to other Federal, State,
and local government agencies, Tribal agencies, and nongovernmental entities that have been authorized access to the
information by statute or regulation and/or as described in the applicable Routine Uses identified in the System of Records
Notice for USDA/FSA-14, Applicant/Borrower. Providing the requested information is voluntary. However, failure to furnish
the requested information may result in a denial for loans and loan guarantees, and servicing of loans and loan guarantees.
The provisions of criminal and civil fraud, privacy, and other statutes may be applicable to the information provided.
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to
respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for
this information collection is 0560-0237. The time required to complete this information collection is estimated to average
10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information. RETURN THIS COMPLETED
FORM TO YOUR COUNTY FSA OFFICE.
The U.S. Department of Agriculture (USDA) prohibits discrimination in all of its programs and activities on the basis of race, color,
national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation,
political beliefs, genetic information, reprisal, or because all or part of an individual’s income is derived from any public assistance
program. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of
program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at (202) 720-2600 (voice and TDD).
To file a complaint of discrimination, write to USDA, Assistant Secretary for Civil Rights, Office of the Assistant Secretary for Civil
Rights, 1400 Independence Avenue, S.W., Stop 9410, Washington, DC 20250-9410, or call toll-free at (866) 632-9992 (English) or
(800) 877-8339 (TDD) or (866) 377-8642 (English Federal-relay) or (800) 845-6136 (Spanish Federal-relay). USDA is an equal
opportunity provider and employer.
Back to top Home
Form Approved –OMB No. 0560-0237
This form is available electronically. (See Page 2 for Privacy Act and Public Burden Statements)
FSA-2005 U.S. DEPARTMENT OF AGRICULTURE Position 3
(03-22-10) Farm Service Agency
CREDITOR LIST
A. INSTRUCTIONS: List all creditors to whom you are presently indebted, or provide alternate docum ents that provide the sam e
inform ation. In the case of an entity, the entity and each individual m em ber must complete this form or provide alternate docum ents.
1. Name:
B. CREDITORS (Complete a separate entry for each creditor)
1A. Name and Address 1B. Telephone Number
1C. Account Number
1D. Contact Person
2A. Name and Address 2B. Telephone Number
2C. Account Number
2D. Contact Person
3A. Name and Address 3B. Telephone Number
3C. Account Number
3D. Contact Person
4A. Name and Address 4B. Telephone Number
4C. Account Number
4D. Contact Person
5A. Name and Address 5B. Telephone Number
5C. Account Number
5D. Contact Person
The U.S. Department of Agriculture (USDA) prohibits discrimination in all of its programs and activities on the basis of race, color, national origin, age, disability,
and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, political beliefs, genetic information, reprisal, or because
all or part of an individual’s income is derived from any public assistance program. (Not all prohibited bases apply to all programs.) Persons with disabilities
who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at (202)
720-2600 (voice and TDD). To file a complaint of discrimination, write to USDA, Assistant Secretary for Civil Rights, Office of the Assistant Secretary for Civil
Rights, 1400 Independence Avenue, S.W., Stop 9410, Washington, DC 20250-9410, or call toll-free at (866) 632-9992 (English) or (800) 877-8339 (TDD) or
(866) 377-8642 (English Federal-relay) or (800) 845-6136 (Spanish Federal-relay). USDA is an equal opportunity provider and employer.
Back to top Home
FSA-2005 (03-22-10) Page 2
6A. Name and Address 6B. Telephone Number
6C. Account Number
6D. Contact Person
7A. Name and Address 7B. Telephone Number
7C. Account Number
7D. Contact Person
8A. Name and Address 8B. Telephone Number
8C. Account Number
8D. Contact Person
9A. Name and Address 9B. Telephone Number
9C. Account Number
9D. Contact Person
C. SIGNATURE
I certify that the information is true, complete, and correct to the best of my knowledge and is provided in good faith. (Warning: Section
1001 of Title 18, United States Code, provides for criminal penalties to those who provide false statements. If any information is found to be
false or incomplete, such finding may be grounds for denial of the requested action.)
1. Signature 2. Date
NOTE:
The following statement is made in accordance with the Privacy Act of 1974 (5 U.S.C. 552a - as amended). The authority for requesting the
information identified on this form is the Consolidated Farm and Rural Development Act, as amended (7 U.S.C. 1921 et. seq.). The information will
be used to determine eligibility and feasibility for loans and loan guarantees, and servicing of loans and loan guarantees. The information collected
on this form may be disclosed to other Federal, State, and local government agencies, Tribal agencies, and nongovernmental entities that have
been authorized access to the information by statute or regulation and/or as described in the applicable Routine Uses identified in the System of
Records Notice for USDA/FSA-14, Applicant/Borrower. Providing the requested information is voluntary. However, failure to furnish the requested
information may result in a denial for loans and loan guarantees, and servicing of loans and loan guarantees. The provisions of criminal and civil
fraud, privacy, and other statutes may be applicable to the information provided.
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection
of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0560-0237. The time
required to complete this information collection is estimated to average 20 minutes per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. RETURN
THIS COMPLETED FORM TO YOUR COUNTY FSA OFFICE.
Back to top Home
Form Approved - OMB No. 0560-0237
This form is available electronically.
(See Page 2 for the Privacy Act and the Public Burden Statements.)
FSA-2006
(07-29-19)
U.S. DEPARTMENT OF AGRICULTURE
Farm Service Agency
Position 3
PROPERTY OWNED AND LEASED
1. Name of Applicant
A. LAND. Include all land owned, to be owned, or leased.
1A. Owner of Record 1B. Description 1C. County
1D. Farm No. 1E. Total
Acres
1F. Crop Acres 1G. Oral/
Written
Lease
1H. Crop
Share
%
1I. Cash Rent 1J. Expiration Date
$
2A. Owner of Record 2B. Description 2C. County
2D. Farm No. 2E. Total
Acres
2F. Crop Acres 2G. Oral/
Written
Lease
2H. Crop
Share
2I. Cash Rent 2J. Expiration Date
% $
3A. Owner of Record 3B. Description 3C. County
3D. Farm No. 3E. Total
Acres
3F. Crop Acres 3G. Oral/
Written
Lease
3H. Crop
Share
%
3I. Cash Rent 3J. Expiration Date
$
4A. Owner of Record 4B. Description 4C. County
4D. Farm No. 4E. Total
Acres
4F. Crop Acres 4G. Oral/
Written
Lease
4H. Crop
Share
%
4I. Cash Rent 4J. Expiration Date
$
5A. Owner of Record 5B. Description 5C. County
5D. Farm No. 5E. Total
Acres
5F. Crop Acres 5G. Oral/
Written
Lease
5H. Crop
Share
5I. Cash Rent 5J. Expiration Date
% $
In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in
or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender identity (including gender expression), sexual orientation, disability, age,
marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded
by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident.
Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible
Agency or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available
in languages other than English.
To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at http://www.ascr.usda.gov/complaint_filing_cust.html and at any USDA
office or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form
or letter to USDA by: (1) mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or
(3) email: program.intake@usda.gov. USDA is an equal opportunity provider, employer, and lender.
Back to top Home
FSA-2006 (07-29-19) Page 2 of 2
B. EQUIPMENT/LIVESTOCK. Include only equipment/livestock to be purchased, currently leased, or to be leased.
1.
Owner of Record
2.
Description
3.
Number of
Units
4.
Rent
$
5.
Share
%
6.
Type of Lease
7.
Expiration Date
C. CERTIFICATION
I certify that the information provided is true, complete, and correct to the best of my knowledge and is provided in good faith.
(Warning: Section 1001 of title 18, United States Code, provides for criminal penalties to those who provide false statements. If
any information is found to be false or incomplete, such finding may be grounds for denial of the requested action.)
1. Signature 2. Date
NOTE:
The following is made in accordance with the Privacy Act of 1974 (5 USC 552a –as amended). The authority for requesting
the information identified on this form is the Consolidated Farm and Rural Development Act, as amended (7 U.S.C. 1921 et.
seq.). The information will be used to determine eligibility and feasibility for loans and loan guarantees, and servicing of
loans and loan guarantees. The information collected on this form may be disclosed to other Federal, State, and local
government agencies, Tribal agencies, and nongovernmental entities that have been authorized access to the information
by statute or regulation and/or as described in the applicable Routine Uses identified in the System of Records Notice for
USDA/FSA-14, Applicant/Borrower. Providing the requested information is voluntary. However, failure to furnish the
requested information may result in a denial for loans and loan guarantees, and servicing of loans and loan guarantees.
The provisions of criminal and civil fraud, privacy, and other statutes may be applicable to the information provided.
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to
respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this
information collection is 0560-0237. The time required to complete this information collection is estimated to average 30
minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information. RETURN THIS COMPLETED
FORM TO YOUR COUNTY FSA OFFICE.
Back to top Home
T his for m is avai lab le el ectr oni cally. F or m Appr oved –OMB N o. 0560- 0238
(See Page 3 for Privacy Act and Public Burden Statements.)
FSA-2037 U.S. DE PART M ENT OF AGRIC ULT URE P osit ion 3
(11-04-10) Farm Service Agency
FARM BUSINESS PLAN WORKSHEET
Balance Sheet
1. NAME 2. Date of Balance Sheet
A –CURRENT ASSETS B –CURRENT LIABILITIES
1A. Cash and Equivalents $ Value 2A. Accounts Payable $ Amount
1B. Marketable Bonds and Securities
1C. Accounts Receivable 2B. Income Taxes Payable
2C. Real Estate Taxes Payable
1D. Crop Inventory
1E.
Measure
1F.
# Units
1G.
$/Unit
$ Value
Notes Payable Due Within 12 Months
2D. Creditor 2E. Purpose
2F.
Interest
Rate
2G. Accrued
Interest
2H. Payment
Amount
2I. Next Payment
Date
2J. Principal
Balance
(1)
1H. Growing Crops
1I.
# Acres
1J.
Cost/Acre
$ Value
(2)
(3)
1K. Market Livestock-Poultry
1L.
# Head
1M.
Weight
1N.
$/Unit
$ Value
(4)
2K. Accrued Interest On: $ Amount
(1) Current Liabilities
(2) Intermediate Liabilities
(3) Long Term Liabilities
1O. Livestock Products
1P.
Measure
1Q.
# Units
1R.
$/Unit
$ Value 2L. Current Portion of Principal Due On:
(1) Intermediate Liabilities
(2) Long Term Liabilities
1S. Prepaid Expenses and Supplies 2M. Other Current Liabilities
1T. Other Current Assets
1U. TOTAL CURRENT ASSETS (Items 1A through 1T) 2N. TOTAL CURRENT LIABILITIES (Items 2A through 2M)
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FSA-2037 (11-04-10) P age 2 of 4
C –INTERMEDIATE ASSETS E –INTERMEDIATE LIABILITIES
3A. Machinery & Equipment/Farm Vehicles (Entered on Page 4) 5A. Creditor 5B. Purpose
3B.
Breeding Stock
3C.
Raised/Purch
3D.
# Head
3E.
$/Head
$ Value
5C.
Interest
Rate
5D. Accrued
Interest
5E. Payment
Amount
5F. Next Payment
Date
5G. Principal
Balance
(1)
(2)
(3)
3F. Notes Receivable
(4)
(5)
3G. Not Readily Marketable Bonds and Securities
(6)
3H. Other Intermediate Assets
(7)
3I. TOTAL INTERMEDIATE ASSETS (Items 3A through 3H) 5H. TOTAL INTERMEDIATE LIABILITIES (Item 5G (1 through 7))
D –LONG TERM ASSETS F –LONG TERM LIABILITIES
4A. Building and Improvements $ Value 6A. Creditor 6B. Purpose
6C.
Interest
Rate
6D. Accrued
Interest
6E. Payment
Amount
6F. Next Payment
Date
6G. Principal
Balance
(1)
(2)
4B. Real
Estate-Land
4C. Total
Acres
4D. Crop
Acres
4E.
%Owned
4F. $/Acre
(3)
(4)
(5)
(6)
4G. Other Long Term Assets $ Value
(7)
4H. TOTAL LONG TERM ASSETS (Items 4A through 4G) 6H. TOTAL LONG TERM LIABILITIES (Item 6GA (1 through 7))
4I. TOTAL FARM ASSETS (From Items 1U, 3I and 4H) 6I. TOTAL FARM LIABILITIES (From Items 2N, 5H, and 6H)
6J. TOTAL FARM EQUITY (Item 4I minus Item 6I)
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FSA-2037 (11-04-10) P age 3 of 4
G –PERSONAL ASSETS H –PERSONAL LIABILITIES
$ Value 8A. Creditor 8B. Purpose
7A. Cash and Equivalents
8C.
Interest
Rate
8D. Accrued
Interest
8E. Payment
Amount
8F. Next Payment
Date
8G. Principal
Balance
7B. Stocks, Bonds
(1)
7C. Cash Value Life Insurance
7D. Other Current Assets
(2)
7E. Household Goods
7F. Car, Recreational Vehicle, Etc.
(3)
7G. Other Intermediate Assets
7H. Retirement Accounts
(4)
7I. Non-Farm Business
7J. Non -Farm Real Estate 8H. Other Liabilities
7K. Other Long Term Assets
7L. TOTAL PERSONAL ASSETS (Items 7A through 7K) 8I. TOTAL PERSONAL LIABILITIES
7M. TOTAL ASSETS (Item 4I and Item 7L) 8J. TOTAL LIABILITIES (Item 6I and Item 8I)
8K. TOTAL EQUITY (Item 7M minus Item 8J)
I - WARNING
I certify that the information provided is true, complete, and correct to the best of my knowledge and is provided in good fa
ith. (Warning: Section 1001 of
Title 18, United States Code, provides for criminal penalties to those who provide false statements. If any information is found to be false or inco
mplete, such
finding may be grounds for denial of the requested action.)
9A. SIGNATURE 9B. DATE
10. COMMENTS
NOTE:
The following statement is made in accordance with the Privacy Act of 1974 (5 USC 552a - as amended). The authority for requesting the information
identified on this form is the Consolidated Farm and Rural Development Act, as amended (7 U.S.C. 1921 et. seq.). The information will be used to
determine eligibility and feasibility for loans and loan guarantees, and servicing of loans and loan guarantees. The information collected on this form
may be disclosed to other Federal, State, and local government agencies, Tribal agencies, and nongovernmental entities that have been authorized
access to the information by statute or regulation and/or as described in the applicable Routine Uses identified in the System of Records Notice for
USDA/FSA-14, Applicant/Borrower. Providing the requested information is voluntary. However, failure to furnish the requested information may result
in a denial for loans and loan guarantees, and servicing of loans and loan guarantees. The provisions of criminal and civil fraud, privacy, and other
statutes may be applicable to the information provided.
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0560-0238. The time
required to complete this information collection is estimated to average 1.25 hours per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. RETURN
THIS COMPLETED FORM TO YOUR COUNTY FSA OFFICE.
The U.S. Department of Agriculture (USDA) prohibits discrimination in all of its programs and activities on the basis of race, color, national origin, age, disability,
and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, political beliefs, genetic information, reprisal, or because all
or part of an individual’s income is derived from any public assistance program. (Not all prohibited bases apply to all programs.) Persons with disabilities who
require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at (202) 720-
2600 (voice and TDD). To file a complaint of discrimination, write to USDA, Assistant Secretary for Civil Rights, Office of the Assistant Secretary for Civil Rights,
1400 Independence Avenue, S.W., Stop 9410, Washington, DC 20250-9410, or call toll-free at (866) 632-9992 (English) or (800) 877-8339 (TDD) or (866) 377-
8642 (English Federal-relay) or (800) 845-6136 (Spanish Federal-relay). USDA is an equal opportunity provider and employer.
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FSA-2037 (11-04-10) P age 4 of 4
J –MACHINERY AND EQUIPM ENT
11A.
Qty.
11B.
Description
11C.
Manufacturer
11D.
Size/Type
11E.
Condition
11F.
Year
11G.
Serial Number
11H.
$ Value
11I TOTAL $ VALUE OF (ITEM 1H)
K –FARM VEHICLES
12A.
Qty.
12B.
Description
12C.
Manufacturer
12D.
Size/Type
12E.
Condition
12F.
Year
12G.
Serial Number/VIN
12H.
$ Value
12I. TOTAL $ VALUE OF (12H)
12J. TOTAL $ VALUE OF (ITEMS 11I AND 12I) TRANSFER TO ITEM 3A)
Back to top Home
This form is available electronically. Form Approved –OMB No. 0560-0238
(See Page 2 for Privacy Act and Public Burden Statements.)
FSA-2038 U.S. DEPARTMENT OF AGRICULTURE Position 3
(08-19- 14) F arm S er vic e A genc y
FARM BUSINESS PLAN WORKSHEET
Projected/Actual Income and Expense
1. NAME
2. For Production Cycle Beginning:
Projected
20 Thru: 20
Actual
A - INCOME
1. Cr op Production and Sal es:
1A. Description
Production
1F.
Farm Use
Purchases Sales
1B.
Acres
1C.
Yield
1D.
% Share
1E.
# Units
1G.
# Units
1H.
$/Unit
1I.
Total $
1J.
# Units
1K.
$/Unit
1L.
Total $
2. Livesto ck an d Po ultry Production and S ales:
2A. Description
2B.
Purch/Raised
2C.
# Units
Purchases
2G.
Death Loss
Sales
P R
2D.
Weight
2E.
$/Unit
2F.
Total $
2H.
# Units
2I.
Weight
2J.
$/Unit
2K.
Total $
3. Dairy L ivest ock Production and S al es:
3A. Description
3B.
Purch/Raised
3C.
# Head
Purchases
3G.
Death Loss
Sales
P R
3D.
Weight
3E.
$/Unit
3F.
Total $
3H.
# Units
3I.
Weight
3J.
$/Unit
3K.
Total $
4. Milk Sales:
4A. Description
4B.
# Head
4C.
Production/Head/Year
4D.
Total Production
4E.
Price
4F.
Sales $
5. Livestock Product Sales:
5A. Description
5B.
Production
5C.
Measure
Sales
5D.
Units
5E.
$/Unit
5F.
Total $
Back to top Home
FSA-2038 (08-19-14) Page 2 of 2
A - INCOME (Continued)
6. Ag Program Payments $ Amount 8. Custom Hire Income $ Amount
7. Crop Insurance Proceeds $ Amount 9. Other Income $ Amount
10. Total Income (Items 1 through 9)
B - EXPENSES
11. Car and Truck
$ Amount
23. Rent – Land/Animals
$ Amount
12. Chemicals 24. Repairs and Maintenance
13. Conservation 25. Seeds and Plants
14. Custom Hire 26. Supplies
15. Feed Supplement 27. Taxes – Real Estate
16. Feed, Grain and Roughage 28. Utilities
17. Fertilizers and Lime 29. Veterinary/Breeding/Medicine
18. Freight and Trucking 30. Other Expenses
19. Gas/Fuel/Oil 31. Other - Irrigation
20. Insurance
21. Labor Hired
22. Rent – Machinery/Equipment/Vehicles 32. Interest
33. Total Expenses (Items 11 through 32)
C – NON-OPERATING
34. Owner Withdrawal
(Total Family Living Expenses
and Non
-
Farm Debt Payments)
36. Non-Farm Income
35. Income Taxes 37. Non-Farm Expense
D - CAPITAL
38. Capital Sales 40. Capital Expenditures
39. Capital Contributions 41. Capital Withdrawals
E - WARNING
I certify that the information provided is true, complete, and correct to the best of my knowledge and is provided in good faith. (Warning:
Section 1001 of Title 18, United States Code, provides for criminal penalties to those who provide false statements. If any information is
found to be false or incomplete, such finding may be grounds for denial of the requested action.)
42A. SIGNATURE
42B. DATE
NOTE:
The following statement is made in accordance with the Privacy Act of 1974 (5 USC 552a - as amended). The authority for requesting the information
identified on this form is the Consolidated Farm and Rural Development Act, as amended (7 U.S.C. 1921 et. seq.). The informa tion will be used to determine
eligibility and feasibility for loans and loan guarantees, and servicing of loans and loan guarantees. The information collected on this form may be disclosed to
other Federal, State, and local government agencies, Tribal agencies, and nongovernmental entities that have been authorized access to the information by
statute or regulation and/or as described in the applicable Routine Uses identified in the System of Records Notice for USDA/FSA-14, Applicant/Borrower.
Providing the requested information is voluntary. However, failure to furnish the requested information may result in a denial for loans and loan guarantees,
and servicing of loans and loan guarantees. The provisions of criminal and civil fraud, privacy, and other statutes may be applicable to the information
provided.
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0560-0238. The time required to
complete this information collection is estimated to average 1.25 hours per response, including the time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. RETURN THIS COMPLETED FORM TO
YOUR COUNTY FSA OFFICE.
The U.S. Department of Agriculture (USDA) prohibits discrimination against its customers, employees, and applicants for employment on the basis of race, color, national origin, age, disability, sex, gender identity, religion, reprisal, and where applicable,
political beliefs, marital status, familial or parental status, sexual orientation, or all or part of an individual’s income is derived from any public assistance program, or protected genetic information in employment or in any program or activity conducted or
funded by the Department. (Not all prohibited bases will apply to all programs and/or employment activities.) Persons with disabilities, who wish to file a program complaint, write to the address below or if you require alternative means of communication for
program information (e.g., Braille, large print, audiotape, etc.) please contact USDA’s TARGET Center at (202) 720-2600 (voice and TDD). Individuals who are deaf, hard of hearing, or have speech disabilities and wish to file either an EEO or program
complaint, please contact USDA through the Federal Relay Service at (800) 877-8339 or (800) 845-6136 (in Spanish).
If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online at http://www.ascr.usda.gov/complaint_filing_cust.html, or at any USDA office, or call (866) 632-9992 to
request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter by mail to U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W.,
Washington, D.C. 20250-9410, by fax (202) 690-7442 or email at program.intake@usda.gov. USDA is an equal opportunity provider and employer.
Back to top Home
This form is available electronically. Form Approved –OMB No. 0560-0237
FSA-2302 U.S. DEPARTMENT OF AGRICULTURE Position 3
(03-22-10) Farm Service Agency
DESCRIPTION OF FARM TRAINING AND EXPERIENCE
INSTRUCTIONS: For new applicants or applicants adding new enterprise only.
1. NAME:
2. TRAINING: Describe completed farm training. Include any courses or training in production or financial management.
3. EXPERIENCE: Describe farm experience. Include the type of operation where experience was gained and the duties and responsibilities of the
position held.
4A. SIGNATURE 4B. DATE
NOTE:
The following statement is made in accordance with the Privacy Act of 1974 (5 U.S.C. 552a - as amended). The authority for requesting the
information identified on this form is the Consolidated Farm and Rural Development Act, as amended (7 U.S.C. 1921 et. seq.). The
information will be used to determine eligibility and feasibility for loans and loan guarantees, and servicing of loans and loan guarantees. The
information collected on this form may be disclosed to other Federal, State, and local government agencies, Tribal agencies, and
nongovernmental entities that have been authorized access to the information by statute or regulation and/or as described in the applicable
Routine Uses identified in the System of Records Notice for USDA/FSA-14, Applicant/Borrower. Providing the requested information is
voluntary. However, failure to furnish the requested information may result in a denial for loans and loan guarantees, and servicing of loans
and loan guarantees. The provisions of criminal and civil fraud, privacy, and other statutes may be applicable to the information provided.
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a
collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0560-
0237. The time required to complete this information collection is estimated to average 20 minutes per response, including the time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the
collection of information. RETURN THIS COMPLETED FORM TO YOUR COUNTY FSA OFFICE.
The U.S. Department of Agriculture (USDA) prohibits discrimination in all of its programs and activities on the basis of race, color, national origin, age,
disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, political beliefs, genetic information, reprisal,
or because all or part of an individual’s income is derived from any public assistance program. (Not all prohibited bases apply to all programs.) Persons
with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s
TARGET Center at (202) 720-2600 (voice and TDD). To file a complaint of discrimination, write to USDA, Assistant Secretary for Civil Rights, Office of the
Assistant Secretary for Civil Rights, 1400 Independence Avenue, S.W., Stop 9410, Washington, DC 20250-9410, or call toll-free at (866) 632-9992
(English) or (800) 877-8339 (TDD) or (866) 377-8642 (English Federal-relay) or (800) 845-6136 (Spanish Federal-relay). USDA is an equal opportunity
provider and employer.
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CONTENTS OF FARM OWNERSHIP LOANS (USDA)

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