Académique Documents
Professionnel Documents
Culture Documents
Signed Complete Federal Income Tax Return(s), and all supporting schedules, for the last three years. (Do not resubmit returns already on file with the bank.)
Signed Detailed Monthly Agricultural Cash Flow Projection
Signed Authorization to Release Financial Information
Applicant__________
Co-Applicant__________
Co-Applicant:
Address:
Address:
Phone #:
Phone #:
Tax ID #:
Tax ID #:
Date of Birth:
Applicant is a:
Date of Birth:
(circle one)
Individual
Partnership
Applicant is a:
Corporation
(circle one)
Individual
Partnership
Corporation
Employer:
Start Date:
CONTINGENT LIABILITIES
Describe and provide the amount of all contingent liabilities for which you are liable such as financial instruments on which you are an endorser, co-maker or
guarantor, lawsuits and other legal actions, and any other special debts on behalf of other parties.
OTHER INFORMATION
YES
NO
Do you have a will? If yes, provide the name of the executor:
Are you a partner or officer in any other venture? If yes, provide information
Are you obligated to pay alimony, child support, or separate maintenance payments? If yes, provide details on a separate attachment.
Are any assets pledged other than as described on the schedules? If yes, provide details on a separate attachment.
Are you a defendant in any suits or legal actions? If yes, provide details on a separate attachment
Have you ever been declared bankrupt? If yes, provide details on a separate attachment.
Are all assets adequately covered by insurance? If yes, provide the name of the insurance company:
Have all required income tax returns been filed and have all tax payments been made? If no, provide details on a separate attachment
The information contained in this application and all supporting schedules is provided for the purpose of obtaining, or maintaining credit with Old National Bank
(hereinafter referred to as "Bank") on behalf of the undersigned, or persons, firms, or corporations in whose behalf the undersigned may either severally or jointly
with others, execute a guaranty in Bank's favor. Each undersigned understands that Bank is relying on the information provided herein ( including the designation
made as to ownership of property) in deciding to grant or continue credit. Each undersigned represents and warrants that the information provided is true and
complete and that Bank may consider this statement as continuing to be true and correct until a written notice of change is given to Bank by the undersigned. Bank
is authorized to make all inquiries it deems necessary and to obtain credit reports from any credit reporting agency to verify the accuracy of the statements made
herein, in connection with Bank's preliminary evaluation of undersigned, or during any periodic review of undersigned deemed necessary by Bank. Bank is
authorized to answer questions about its credit experience with me / us.
Signature:
Date:
Signature:
Date:
Signature:
Date:
Signature:
Date:
Revised 01/05
Type
Held In Name Of
Tot. Cur.
Pledged
Mkt. Val.
On Notes
0
Record this amount on the Ag Financial Statement - Line 1
Shares
Shares Held By
Held In Name Of
Tot. Cur.
Pledged
Mkt. Val.
On Notes
0
Record this amount on the Ag Financial Statement - Line 2
Account Type
Account Held By
Held In Name Of
Tot. Cur.
Pledged
Mkt. Val.
On Notes
0
Record this amount on the Ag Financial Statement - Line 19
Policy Owner
Beneficiary
Net
Face
Cash
Policy
Cash
Pledged
Amount
Value
Loans
Value
On Notes
0
0
0
0
0
Commodity
Futures
Long
OR
Or
Premium
Current
Or
Premium
Contract
Contract
Total
Or
Current
Option
Short
of
Futures
Price
Contract
Mkt. Price
Mkt.
Gain
Pledged
(F,O)
(L,S)
Contracts
Month
Amount
Value
(Loss)
On Notes
0
Record this amount on the Ag Financial Statement - Line 4
Payment
Expected
Total
Purchase Money
Accrues
Receipt
Balance
Pledged
Description
To
Date
Due
On Notes
Due From:
Due From:
Original
Under
Extended Payment
90 Days
Total
Arrangements
Purchase Money
Due
Original
30
30 to 89
and
Balance
Payment
Description
Date
Balance
Days
Days
Over
Due
Amount
0
0
0
0
0
Record this amount on the Ag Financial Statement - Line 10
Description
Average
Unit
Tot. Cur.
Pledged
Head
Weight
Mkt. Val.
Mkt. Val.
On Notes
Payment
Pledged
Frequency On Notes
Description
Average
Unit
Tot. Cur.
Pledged
Head
Weight
Mkt. Val.
Mkt. Val.
On Notes
0
0
0
0
0
0
0
Description
Unit
Unit
Tot. Cur.
Pledged
Units
Measure
Mkt. Val.
Mkt. Val.
On Notes
0
0
0
0
0
0
0
0
0
0
Description
Unit
Unit
Tot. Cur.
Pledged
Units
Measure
Mkt. Val.
Mkt. Val.
On Notes
0
0
0
0
Description
Acres
Invest.
Pledged
Planted
@ Cost
On Notes
Value
Description
Unit
Unit
Tot. Cur.
Units
Measure
Value
Mkt. Val.
Pledged
On Notes
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Schedule 15 - Farm Machinery, Equipment, and Vehicles Held Under Capital Leases
Year
Description
Year
Make
Model
Acquired
Total Farm Machinery, Equipment and Vehicles Held Under Capital Leases
Cost
Book
Tot. Cur.
Pledged
Value
Mkt. Val.
Owned
On Notes
Year
Make
Model
Acquired
Cost
Book
Tot. Cur.
Ownship
Pledged
Value
Mkt. Val.
Owned
Share
On Notes
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Record this amount on the Ag Financial Statement - Line 15
Schedule 17 - Farm Machinery, Equipment, and Vehicles Held Under Operating Leases
Description
Year
Make
Model
Date
Expiration
Payment
Payment
Acquired
Date
Amount
Frequency
Total Farm Machinery, Equipment and Vehicles Held Under Operating Leases
Tillable
Acres
Mkt. Val.
Description / Location
Mkt. Val.
Acres
Improved
Total
Tot. Cur.
Pledged
Mkt. Val.
Acres
Mkt. Val.
On Notes
#DIV/0!
0
Record this amount on the Ag Financial Statement - Line 16
Tillable
Acres
Mkt. Val.
Description / Location
Mkt. Val.
Acres
Partial Totals
Improved
Total
Tot. Cur.
Mkt. Val.
Pledged
Mkt. Val.
Acres
Mkt. Val.
Owned
Owned
On Notes
#DIV/0!
0
Record this amount on the Ag Financial Statement - Line 17
Tillable
Annual
Nontillable
Annual
Improved
Annual
Total
Acres
Rents
Acres
Rents
Acres
Rents
Acres
Annual
Rents
0
Lease
Lease
Lease
Type
Terms
Expires
Acquired
Cost
Tot. Cur.
Mkt. Val.
Pledged
Mkt. Val.
Owned
Owned
On Notes:
0
0
0
0
0
Description
Unit
Unit
Tot. Cur.
Units
Measure
Value
Mkt. Val.
Pledged
On Notes:
0
0
0
0
0
0
0
0
Vendor / Payee
Under
Extended Payment
90 Days
Total
Arrangements
Purchase Money
Due
Original
30
30 to 89
and
Balance
Payment
Payment
Accrued
Description
Date
Balance
Days
Days
Over
Due
Amount
Frequency
Interest
0
0
0
0
0
0
Total Accounts Payable
0
Combine with Schedule 26 and record total on the Ag Financial Statement - Line 22
Creditor
Note
Maturity
Original
Current
Payment
Payment
Accrued
Collateral Description
Date
Date
Balance
Balance
Amount
Frequency
Interest
0
Record this amount on the Ag Financial Statement - Line 23
Description
Unit
Unit
Total
Units
Measure
Value
Amt. Due
Accrued
Interest
0
0
0
0
0
0
Total Other Current Liabilities
Prin. Bal.
Avg. Mo.
Total
Avg. Yrly
Beyond
Accrued
To Month?
Payment
Amt. Due
Payment
12 Months
Interest
Creditor
0
0
0
0
0
Total Credit Card Debt
Combine with Schedule 23 and record total on the Ag Financial Statement - Line 25
Record this amount on the Ag Financial Statement - Line 28
Credit Type
Creditor
Payment
Within
Beyond
and
Note
Maturity
Original
Current
Payment
Payment
Within 12
12
12
Collateral Description
Date
Date
Balance
Balance
Amount
Frequency
Months
Months
Months
Description
Within
Beyond
Unit
Unit
Total
Payment
Payment
Within 12
12
12
Units
Measure
Value
Amt. Due
Amount
Frequency
Months
Months
Months
Accrued
Interest
Interest
Accrued
0
Record this amount on the Ag Financial Statement - Line 27
Record this amount on the Ag Financial Statement - Line 30
ANNUAL CROP AND OTHER FARM PRODUCT PRODUCTION SUMMARY AND PROJECTION
PROJECTED
Property Description
Prior Year 1
Prior Year 2
Acres
Production
Acres
Production
Farmed or
Per
Total
Average
Total
Farmed or
Per
Total
Average
Total
Farmed or
Acres
Production
Per
Total
Average
Total
Crop
Production
Base
Units
Price Per
Mkt. Val.
Production
Base
Units
Price Per
Mkt. Val.
Production
Base
Units
Price Per
Mkt. Val.
or
Base
Unit
Produced
Unit
Produced
Base
Unit
Produced
Unit
Produced
Base
Unit
Produced
Unit
Produced
Product
$0.00
$000
$0.00
$000
$0.00
$000
Description
Prior Year 1
Average
Average
Prior Year 2
Average
Average
Average
Total
Weight
Total
Price
Total
Total
Weight
Total
Price
Total
Total
Weight
Total
Price
Total
Head
Per
Weight
Per
Mkt. Val.
Head
Per
Weight
Per
Mkt. Val.
Head
Per
Weight
Per
Mkt. Val.
Produced
Head
Produced
lb.
Produced
Produced
Head
Produced
lb.
Produced
Produced
Head
Produced
lb.
Produced
lbs.
$0.00
$000
lbs.
$0.00
$000
lbs.
$0.00
$000
Name :
Signature :
Completed as of :
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sept
Oct
Nov
Dec
31
28
31
30
31
30
31
31
30
31
30
31
Capital Receipts:
31
0
7
8
Non-Farm Income:
9
10 Total Cash Available (add lines 1 - 9)
11
12
13
14
15
16
17
18
19
20
21
22
23
24
27
28
29
30
Operating Expenses:
Grain Storage
Fertilizer, Chemicals and Lime
Gas, fuel, oil & Propane for drying
Insurance (property, liability, crop)
Marketing and Transportation Expense
Rents and leases - Land
Rents and leases - Machines
Repairs - Equipment and Machines
Seed
Storage and Custom Drying
Supplies
Taxes ( real estate & personal property)
Utilities (farm share)
Farm Management
37
38
39
40
41
42
44
31
0
0 25
0 26
0 27
0 28
0 29
0 30
0 32
0 33
0 10
0 13
0 14
0 15
0 16
0 17
0 18
0 19
0 20
0 21
0 22
0 23
0 24
0
- Principal
- Interest
(add lines 28 - 33)
43
28
0
0 31
0 12
Capital Expenditures:
Machinery & Equipment
Buildings, Land & Improvements
Other Expenditures:
Family Living withdrawals
Income tax and social security
Mortgage
33
34
0 11
31
32
Jan 200_
5
6
0 34
0 35
0 36
0
0 37
0 38
0
0 39
0 40
0 41
0
0 42
0 43
0 44
Loan Balance
Interest Rate for 1st $200,000
Interest Rate over $200,000
6.54%
8.00%
200_
200_
$0
$0
$0
Income Acres:
124
FILENAME:
0
0
###
Cash Available
Average
0
0
0
0
0
0
###
###
###
###
0
0
0
Date :
Evansville, IN 47705
0
Debtor agrees to provide to Old National Bank a written list of the buyers, commission merchants and selling agents to or through whom the
Debtor may sell the farm products described in the Security Agreement given to Old National Bank and executed by Debtor on the "Security
Agreement Date" specified above. As used in this document, the terms "farm products," "buyers," "commission merchants, " and "selling
agents" have the meanings given to them by the Federal Food Security Act of 1985.
Debtor is providing to Old National Bank the following list of potential buyers, selling agents and commission merchants to or through whom
Debtor anticipates selling the farm products described in the Security Agreement executed by Debtor on the "Security Agreement Date"
specified above. Debtor is aware that sale of the farm product collateral to or through anyone not on this list is illegal unless the Debtor notifies
Old National Bank in writing of the identity of the buyer, selling agent, or commission merchant at least 7 days prior to the sale or Debtor
accounts to Old National Bank for the proceeds of the sale not later than 10 days after the sale. The Debtor agrees that Old National Bank may
require any check or draft issued as full or partial payment for the sale of farm products to be make payable to both Debtor and Old National
Bank. The Debtor agrees to keep this list current and to promptly notify Old National Bank of any changes to this list.
Debtor and Old National Bank intend that the above terms and the following list amend and become a part of the Security Agreement
described above.
Name
Address
Farm Products
If checked, this list replaces any prior list provided by Debtor to Old National Bank. Debtor agrees not to sell any farm products covered by
the described Security Agreement to anyone named on any prior list unless that same person or entity is also listed above.
Secured Party:
By:
0
0
0
Re:
Date :
0
Name of Debtor
0
Name of Debtor
0
0
The Debtor has named you as a potential buyer, commission merchant or selling agent of farm products. You are hereby given notice
pursuant to the Food Security Act of 19985 that the Debtor has given a security interest to Old National Bank in (1) the farm products
described below and (2) any proceeds from the sale of such farm products. This notice is effective for 1 year from the date you receive it.
AGRICULTURAL COMMODITIES:
Description
Crop Year(s)
All Grain
#REF!
Amount
Unlimited
LIVESTOCK:
Description
Amount
Crop Year(s)
Amount
If no amount is specified for the above described farm products, the security interest covers all such farm products without limitation as to
amount. The farm products described above are or may be located on (describe property and county or parish where farm products are or
may be located):
X The security interest also covers the described farm products wherever located and is not limited to those located on the above property.
PAYMENT OBLIGATIONS
You will be subject to the security interest of Old National Bank in the farm products unless the following payment obligations are satisfied:
X Any check or draft issued to borrower as full or partial payment for any sale of such farm products must be made payable to both the
Debtor and Old National Bank, delivered to or received by Old National Bank, and finally paid.
X If property other than checks or drafts is given as full or partial payment for the sale of such farm products, you must deliver a written
notice describing the property in detail to Old National Bank at the address stated above within three days after such sale.
Satisfaction of the payment obligations will not affect the security interest of the Secured Party in proceeds of the sale of such farm products.
As of
Applicant:
Co-Applicant:
ASSETS
Market Value
Current Assets
1
Schedule 1
Marketable Securities
Schedule 2
Schedule 6
Schedule 5
Schedule 8
Schedule 10
Schedule 11
Schedule 12
Schedule 13
10
Other Receivables
Schedule 7
11
Schedule 4
12
Schedule 14
Non-Current Assets
13
Schedule 9
14
Schedule 15
15
Schedule 16
16
Schedule 18
17
Schedule 19
18
Schedule 21
19
Schedule 3
20
Schedule 22
TOTAL ASSETS
Schedule 17
22
Accounts Payable
Schedule 23
23
Schedule 24
24
Schedule 25
25
Schedule 26
26
Schedule 27
27
Schedule 28
Non-Current Liabilities
28
Schedule 26
29
Portion of Long Term Loans and Capital Leases Due Beyond 12 Months
Schedule 27
30
Schedule 28
TOTAL LIABILITIES
NET WORTH