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F ed e r a l R eserve B a n k OF DALLAS DALLAS. TEXAS May 26, 1952 To the Member Banks in the Eleventh Federal Reserve District: Enclosed are sample copies of financial statement forms C-5 and C-6, recently revised to include suggestions made from time to time by our member banks, and which we feel are more suitable than the forms heretofore furnished. The revised forms are carried in stock by this bank and its branches at El Paso, Houston, and San Antonio, for use by our member banks. Form C-5 is intended for individuals and partnerships engaged in farming or livestock activities, while form C-6 is adapted to individuals, partnerships, and corpora tions engaged in commercial businesses. The financial statement forms, as well as our stand ard chattel mortgage form C-2, are available to our member banks without charge. We shall be glad to give prompt attention to all requests for these forms. Yours very truly, R. R. GILBERT President This publication was digitized and made available by the Federal Reserve Bank of Dallas' Historical Library (FedHistory@dal.frb.org) FORM C-5 REV. 1951 FEDERAL RESERVE BANK OF DALLAS Individual Patrnership FINANCIAL STATEMENT— F A R M ER -ST O C K M A N Nam e Bank To Address BUSINESS For the purpose of procuring credit from time to time, the undersigned hereby submits the following statement of condition os of _____________________ 19_________ __ . The undersigned hereby maintains and guarantees that said statement is in all respects true and correct; any you m ay consider as continuing to be true and correct unfit written notice of a change is given to you by the undersigned. PROPERTY OWNED BY THE UNDERSIGNED DEBTS DUE BY THE UNDERSIGNED $ $ Cash Value Life Insurance— less borrowings........... ................ Other Current Debts.......................................................... TOTAL CURRENT A SS E T S ............................................. TOTAL CURRENT DEBTS............................................. TOTAL LIABILITIES...................................................... NET W O R T H ................................................................ T O T A L..................................................................... $ TOTAL A SS E T S ............................................................ $ Amount of Assets listed above which are exempt by la w ............................. ........................................................................................ $. Amount for which undersigned individual is liable for partnership obligations.................................... ............ .......................... .............. $. Amount of assets listed above which are pledged to secure debts of the undersigned................................................................................$. Amount for which the undersigned is liable on notes or accounts, not included in above statement, which have been transferred to banks or others... Amount of liability incurred by endorsement or guaranty to accomodate others......................................................................................... $. Amount of liability on bonds o r unfinished contracts................................................................................................................... ...........$. Amount of insurance carried on feed $ _____________________________ ; on improvements $ _____________________________ ; and on other assets $_____________________________ Amount of life Insurance carried $ _____________________________ in favor o f __________________________________________________________________ ____________ ____________________ __ Numberof years in present business_____________________________ Number of years at present location__________________________________________________________________________— Number of acres leased from others_____________________________ Date lease expires___________________________________________ -______________________________________________ Date to which lease is paid_________________________________________________ Amount of yearly rent paid for leased la n d ................. .........$_________________________ __ ______ The undersigned declares and certifies that the above statement and schedules on opposite side are true and correct account of the condition of my/our business on the d a y above stated. W ITNESS: ___________________________________________________________________________________(Signature)_________________________________________ ___ _____ ____________________________ W e certify this to be a correct copy of statement held In our files. (Name o f Bank) By. (Title) (FILL BLANKS O N OTHER SIDE) SCHEDULES REAL ESTATE A cre age or Dimensions Location V A LU A T IO N Description of Improvements Number of Acres in Cultivation LIENS Actual Assessed Title in W hose Name Amount W hen Due T O T A L S .................................... STOCKS AND BONDS OWNED Nam e of Corporation Maturity Location Par Value Date of Last Dividend or Interest Actual Value Nature of Business Rate T O T A L S ................ FARM PRODUCTS AND FEED ON HAND Description Quantity MACHINERY AND TOOLS PURCHASED Total Amount Market Cost Date $ Bu. of C orn. .......... ................ . @ Present Value Description—-M a k e Number Tractor $ Tractor Autos Trucks Combines Threshers Enaines Other Took T O T A L .............. T O T / a ........... LIVE STOCK Number of Head Class of Stock (Registered, Graded, etc.) Market Value Per Head Breed Amount Steers, I s ..................... @ $ $ Steers, 2 s ......... * ..........@ $ $ Steers, 3 s ..................... @ $ $ Steers, 4s and u p .......... @ s $ Heifers, I s and 2 s . - @ $ $ Cow s........................... @ $ C clves......................... @ $ Bulls............................ @ $ $ Horses........ * .............. @ $ $ Col ts $ s .......... . @ $ $ M u le s . ......................... @ $ $ Mule Colts....................@ $ $ S h e e p ..........................@ $ $ $ $ G o a ts..........................@ $ $ K $ $ i d s . @ • O th e r.......................... @ . $ $ . $ $ ... $ $ T O T A L ................................. ....................................... $ II o partnership, fill oul the following schedule:________________________________P A R T N E R S ... A ddreM Nam es of General Partners 1 | Interest in Business Amount Due to Firm Time Devoted to Business Estimated Net Worth Outside This Business . NOTE: If you have ever failed in business, attach a complete explanation and state basts of settlement with creditors. Taxes have been paid to_____________________________________ 1 9 ________________ . M o rtga ge Interest has been paid to_____________________________________ 19. Land under lease: acres of_ _land. Rental price is $ . which has been paid to _ Statements submitted to Federal Reserve Bank must be either signed originals or certified copies. It Is the practice of the Federal Reserve Bank to retain In Its files all financial statements submitted with notes therefore, when a member bank submits an original it is expected to retain a copy for its own flies. [OVER) FORM C-6 REV. 1951 FEDERAL RESERVE BANK OF DALLAS Individual Partnership Corporation FINANCIAL STATEMENT— COMMERCIAL Nam e Bank To Address Business Location 19 For the purpose of procuring credit from time to time, the undersigned hereby submits the following statement of condition as of_ The undersigned hereby maintains and guarantees that said statement is in ail respects true and correct; and you may consider the same as continuing to be true and correct until written notice of a change is given to you by the undersigned. ASSETS LI ABI LITIES $ $ Life insurance, Cash Va lu e — less borrow ings.................. . Other Current Assets (describe fully)............... ..................... - Total Current Assets Machinery and Fixtures (Cost $ Total Current Liabilities 1......... Total Liabilities Net Worth (if individual or partnership) Total Capital Stock* Surplus and Profits* (*Fill out above 2 lines if Corporation) Total Assets Total $ $ Amount of assets listed above which are exempted by la w .................. ........................................... ..................................................... $_ Specify any of the above assets pledged as collate ral. ............ .......... ............. ................ ............................................................. $_ Specify any of the above liabilities secured b y collateral........... ...................................................................................... ................... $_ C O N T IN G EN T LIABILITY: Upon accomodation notes $______________________________ As endorser $ _____________________________ As guarantor $_ Judgements or suits pending against the undersigned at this time...................... ..................................................................................... $_ INSURANCE: O n Merchandise $ ________________________________________Buildings $ ________________________________________ Machinery $______ _ LIFE INSURANCE: Amount $ ___________________________________ Encumbered for $ ___________________________________ To whom pa yab le ________ The undersigned declares and certifies that the above statement and schedules on reverse side are a true and correct account of the condition of my/our business on the d a y above stated. W ITNESS: ___________________________________________________________________________ (Signature) W e certify this to be a correct copy of statement held in our files. (Name of Bank) By. (Title) (FILL BLANKS O N OTHER SIDE) STOCKS AND BONDS OWNED Location Description— Nam e of Corporation Par Value Actual Value Date Last Dividend or Interest Rate Nature of Business REAL E5TATE SCHEDULE VA LU A TIO N Description— Location— Dimensions LIENS Title in W hose Nam e Nature of Improvements Assessed PROFIT AND LOSS STATEMENT, for Year Ended____________________ 19_____ W hen Due Actual Amount RECONCILEMENT OF SURPLUS OR NET WORTH $ Surplus or Net Worth Previous P e rio d ...... ........................ $ $ t Other additions to Surplus or Net Worth: Less— Operatina Expenses.................... •£ Rent........................................... Salarie s...................................... Deductions: Dividends paid ................... $ W ithdraw als...................... $ Depredation. B ad D ebts................ O ther................................ $ Total Deductions........................... Total Deductions..................................$ Other Income, Investments, etc.*................. ......... ............ Present Surplus or Net W o rth ........................................... $ TOTAL IN C O M E ............................................................. $ If a PARTNERSHIP, fill out the following Schedule: Names of General Partners Interest in Business Address $ Amount Due to Firm $ Time Devoted to This Business Estimated Net Worth Outside This Business $ Date and amount of last dividend p a id — (Date)__________________________________________________________ (Amount) $ A ve rage terms on sales__________________________________________ _ _ _ ____________A verage terms on purchases______ Time of ye ar when notes and accounts receivable are generally maximum, date____________________________ _ Amount $ _ Minimum, d a te _____________________________________Amount $ ______________________________________ Time of ye ar when stock of merchandise is generally maximum, d a t e ________________________________________Amount $ __ Minimum, d a te _____________________________________ Amount $_______________________________________ Time of year when liabilities are generally maximum, date _ _ _ _ _________________________________________ Amount $__ Minimum, d a t e ____________________________________ Amount $______________________________________ Is statement based on actual inventory?— If so, date ________________________ ____ _________________ If not, how? Have books been audited b y a public accountant? __________________ , d a te __________________ By whom _______ ________ If you have ever failed in business, attach a complete explanation and state basis of settlement with creditors. OTHER DATA: ___ ___________________________________________________________________________________________________ Statements submitted to Federal Reserve Bonk must be either signed originals or certified copies. It Is the practice of the Federal Reserve Bank to retain in its files all financial statements submitted with notes? therefore, when a member bank submits an original it is expected to retain a copy for its own files. ' (OVER)
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