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federal reserve bank of Da l l a s D ALLAS, TEXAS March 29, 1963 To All Member Banks of the Eleventh Federal Reserve District: For a number of years, as a service to our member banks, we have furnished the following financial statement form s: C-5 Finan cial Statement — Farmer-Stockman, C-6 Financial Statement — Commercial and C-7 Comparative Statements. We now have available two additional forms: C-5A Operating Statement — Farmer-Stockmen and C-8 Personal Financial State ment. Sample copies of the later two forms are enclosed for your review and consideration of possible use by your bank. Copies of any of the above forms are available to member banks without cost and will be supplied upon request to this bank or appropriate branch. Yours very truly, Watrous H. Irons President This publication was digitized and made available by the Federal Reserve Bank of Dallas' Historical Library (FedHistory@dal.frb.org) FORM C-5A FEDERAL RESERVE BANK OF DALLAS OPERATING STATEMENT — FARMER-STOCKMAN Name. Address. Date. To Bank City ESTIMATED INCOME FROM CROPS (Current Y e a r) Crop Yield Per Acre Acreage Price Per Unit Production Cotton $ State ESTIMATED INCOME FROM LIVESTOCK AND PRODUCTS Operator's Share of Gross Cash Income Gross Cash Income $ Units Sold Commodity Cattle $ Owned $ Operator’s Share of Gross Cash Income Gross Cash Income $ $ $ $ Calves Rented Price Per Unit Sheep Lambs G rain Owned Hogs Rented Milk Owned M ohair Wool Rented Owned Rented TOTALS $ $ TOTALS TOTAL INCOME Farm income Previous Years Current Year (Estimated) Item 19 19 19 19 19 $ $ $ $ $ $ $ $ $ $ $ $ Sale of crops (see above) Sole of livestock and products (see above) Government payments Total Farm Income Nonfarm income O il and gas leases O il and gas income Total Nonfarm Income GRO SS INCOM E Less Expenses NET INCO M E SCHEDULE OF ESTIMATED EXPENSES (Current Year) Feed February Janu ary Item March M ay A pril Ju ly June August September October November December Total $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Seed Fertilizers Pesticides Fuel, oil Livestock purchases M achinery rep air M achinery hire Hired labor Auto-truck expenses Taxes, insurance Living expenses M aior fam ily purchases TOTAL EXPENSES Form C-8 Federal Reserve Bank of Dallas PERSONAL Nome. FINANCIAL STATEMENT .Bank Tot Address. State City Telephone. Business or Occupation____________________________________________________________________________________________________________________ — ____________________________ Partner or Officer in any other venture_________________________________________________________________________________________________________________________________ Age________________________________________ M arried________________________________________ Single_______________________________________ No. of Dependent Children. A re any assets pledged?_____________________________________________________________________________ _________ ___________________________________________________________ Have you ever made a composition settlement or taken bankruptcy? Exp lain:______________________________________________________________________ -——----- For the purpose of procuring and m aintaining credit from time to time in any form whatsoever with the above named Bank, for claims and demands against the undersigned, the undersigned submits the following as being a true and accurate statement of its financial condition on the following date, and agree that if any change occurs that m aterially reduces the means or a b ility of the undersigned to pay a ll claim s or demands against it, the undersigned w ill im m ediately and without d elay notify the said Bank, and unless the Bank is so notified it may continue to rely upon the statement herein given as a true and accurate statement of the financial condition of the undersigned as of the close o f business.......................................................................................................................................-......, 19--------- - ASSETS Cash on Hand and in Banks (Schedule 1) LIABILITIES AND NET WORTH $ Notes Payable to Banks — Secured (Schedule 1) $ Unsecured (Schedule 1) U. S . Government Securities Accounts, Loans and Notes Receivable (Schedule 2) Notes Payable to Relatives Cash Surrender Value lif e Insurance (Schedule 3) Accounts and Notes Payable to Others Other Stocks and Bonds (Schedule 4) Rents and Interest Due Real Estate (Schedule 5) Taxes Due (Schedule 5) Automobiles — Number ( Liens on Real Estate (Schedule 5 ) ) Other Assets (Itemize) Other Liabilities (Itemize) TOTAL LIABILITIES NET WORTH TOTAL ASSETS $ TOTAL LIA BILITIES AND NET WORTH CONTINGENT LIABILITIES SOURCE OF INCOME Salary $ $ As Endorser or Co-Maker Bonus and Commissions Dividends and Interest $ On Leases or Contracts Legal Claims Real Estate Income Provision for Federal Income Tax O ther Special Debt TOTAL INCOM E $ COMPARISON OF MONTHLY INCOME AND EXPENSES INSURANCE COVERAGE Fire Insurance — Buildings Household Effects and Autos Liability Insurance — Automobiles $ Net Monthly Income Rent or Home Payment Food and Utilities Personal Incidentals G eneral Public Other Insurance $ $ A vg . Amt. Paid on Open Accts. TOTAL EXPENSES $ DIFFERENCE BETW EEN INCOM E AND EXPENSES $ (SEE OTHER SIDE) SCHEDULES No. 1. Banking Relations. (A list of all my bank savings and loan accounts.) Name and Location Amount of Loan Cash Balance $ Maturity of loan How Endorsed, Guaranteed or Secured $ No. 2. Accounts, Loans and Notes Receivable. (A list of the largest amounts owing to me.) Amount Owing Name and Address of Debtor Age of Debt Description or Nature of Debt Date Payment Expected Description of Security Held No. 3. Life Insurance. Name of Person Insured Name of Beneficiary Name of Insurance Co. Type of Policy Face Amount of Policy Total Cash Surrender Value Total Loans Against Policy Amount of Yearly Premium Is Policy Assigned? No. 4. Other Stocks and Bonds. Face Value Bonds No. Stock Shares Description of Security Registered in Name of Cost Present Market Value Income Received Last Year If Pledged State to Whom No. 5. Real Estate. The legal and equitable title to all the real estate listed in this statement is solely in the name of the undersigned, except as follows:______________________________________________________________________________________________________________________________________________ Description or Street No. Dimensions or Acres Improvements Consist of Mortgages or Liens Due Dates and Amounts of Payments Assessed Value Present Market Value Unpaid Taxes Year Amount The undersigned certifies that the information inserted on each side hereof has been carefully read and is true and correct. Date. Signed-
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