Clone of Personal Financial Statement

Address

Street Address Line 2

CityState

Zip Code

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Format: (000) 000-0000.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Format: (000) 000-0000.

Rows	Owner 1	Owner 2	Owner 3	Owner 4	Owner 5
Name
Roles (Owner/Guarantor)
Ownership %
Date of Birth
Address
Phone Number
E-mail Address

BorrowerAccountantOther

Rows	Crop 1	Crop 2	Crop 3	Crop 4	Crop 5
Crop
Acres (Owned)
Acres (Rented)
Expected Yield/Acre
Expected Price/Unit
Expected Gross Revenue

Rows	Animal 1	Animal 2	Animal 3	Animal 4	Animal 5
Description
Enterprise
Beginning Inventory (Head)
Expected Sale (Head)
Avg Weighted / Head
Expected Price / Cwt or Head
Expected Gross Revenue

Rows	Collateral 1	Collateral 2	Collateral 3	Collateral 4	Collateral 5
Description
Serial / VIN
Location
Estimated Market Value
Lienholder
Lien Position

Certification & Authorization

I/We certify that all information provided in this financial statement, including any attachments, is true, correct, and complete to the best of my/our knowledge. I/We understand that Peoples Bank of Kentucky, Inc. (“Bank”) will rely on this information in evaluating my/our creditworthiness.

I/We authorize the Bank to obtain consumer reports and to make any other inquiries it considers necessary and appropriate, to the extent permitted by law, for the purpose of (1) evaluating this application for credit, (2) reviewing, renewing, or increasing any credit that may be extended, and (3) collecting any amounts owed. I/We authorize the Bank to verify any information contained in this statement, including contacting my/our employer(s), creditors, and financial institutions.

I/We further authorize the Bank to provide information regarding its credit experience with me/us to credit reporting agencies and to other creditors, as permitted by law. I/We agree to promptly notify the Bank in writing of any material change in the information provided in or with this statement and to furnish such additional information as the Bank may reasonably request.

By signing below, I/We acknowledge that I/We have read, understand, and agree to the above Certification & Authorization.

Agriculture Financial Statement

Applicant Information

Applicant Information - Continued...

Operation Profile

Balance Sheet: Assets

Current Farm Assets

Intermediate & Long-Term Farm Assets

Personal / Non-Farm Assets

Balance Sheet: Liabilities

Current Farm Liabilities

Intermediate & Long-Term Farm Liabilities

Personal / Non-Farm Liabilities

Farm Income Statement

Farm Revenues - Last Full Year

Farm Expenses - Last Full Year

Personal / Non-Farm Income

Personal / Non-Farm Expense

Production & Collateral

Crop Production Schedule

Livestock Production Schedule

Collateral Schedule (Major Items)

Contingent Liabilities & Certification