P&SP 3410 Supplemental Balance Sheet - Dealer or Market Agency

OMB CONTROL NO. 0580-0015
U.S. DEPARTMENT OF AGRICULTURE
GRAIN INSPECTION, PACKERS AND
STOCKYARDS ADMINISTRATION
PACKERS AND STOCKYARDS PROGRAM

SUPPLEMENTAL BALANCE SHEET
SPECIAL REPORT

1. Name and Address (include 9 digit Zip Code) (make necessary changes to name and address)

2. Telephone Number

3. Balance Sheet As Of (Date) _____________________
Assets
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Current Assets
♦ Cash
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On Hand................................................................................ $ ____________ (4)
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General Bank Account (enter overdraft below on line 41).... +_____________ (5)
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Overage in Analysis of Custodial Account ........................... +_____________ (6)
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Total Cash..................................................................................................... $____________ (7)
♦ Inventories
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Livestock...............................................................................
____________ (8)
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Other Inventories……………………………………………
____________ (9)
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Total Inventory............................................................................................. _____________ (10)
♦ Marketable Securities: U.S. Government Bonds and Others
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Total Marketable Securities ....................................................................... _____________ (11)
♦ Accounts Receivable
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One Year Old or Less
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Due from Trade ............................................................. +____________ (12)
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Due from Affiliates and Subsidiaries ............................ +____________ (13)
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Due from Officers ......................................................... +____________ (14)
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Due from Employees..................................................... +____________ (15)
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Due from Others............................................................ +____________ (16)
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Subtotal ........................................................................ +____________ (17)
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Receivables not Due within One Year………………… (____________) (18)
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Subtotal ................................................................................ _____________ (19)
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Less Allowance for Doubtful Accounts ................................ (____________)(20)
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Total Accounts Receivable (line 19 – line 20) ............................................. ______________ (21)
♦ Total Notes Receivable Within One Year (including portion of long term notes due within one year)
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Total Notes Receivable ................................................................................ ______________ (22)
♦ Other Current Assets
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Prepaid Expenses .................................................................. ____________ (23)
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Interest Receivable................................................................ +____________ (24)
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Other (specify) ...................................................................... +____________ (25)
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Total Other Current Assets......................................................................... _____________ (26)
♦ Total Current Assets (add lines 7, 10, 11, 21, 22, and 26)..............................................................
$___________ (27)

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Investments
♦ Farms and Real Estate not Used for Stockyard Purposes....................................... _____________ (28)
♦ Stocks and Bonds (cost or market value, whichever is lower) ............................... +____________ (29)
♦ Other (specify) ....................................................................................................... +____________ (30)
♦ Total Investments............................................................................................................................. ___________ (31)
♦
Fixed Assets Used For Stockyard Purposes
♦ Land ....................................................................................................................... _____________ (32)
0.00 (33)
♦ Buildings, Structures, and Equipment.................................................................... +____________
♦ Less Allowance for Depreciation........................................................................... (____________) (34)
♦ Total for Buildings, Structures and Equipment...................................................... _____________ (35)
♦ Total Fixed Assets Used For Stockyard Purposes ........................................................................._____________ (36)

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AUGUST 2007

Form P&SP-3410

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Other Assets
♦ Long-term Notes Rceivable (not due within one year) (excluding
portion reported in line 22 above)………………………………………………… $____________ (37)
♦ Other (specify) ....................................................................................................... +____________ (38)
♦ Total Other Assets........................................................................................................................ $____________ (39)

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Total Assets (add lines 27, 31, 36, and 39) ………………………………………………………………… $_____________ (40)

Liabilities and Net Worth
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Current Liabilities
♦ Bank Overdraft (according to the reporting firm’s books) ........... $____________ (41)
♦ Shortage in Analysis of Custodial Bank Account ......................... _____________ (42)
♦ Payables, Accruals, and Other Liabilities
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Due to Trade ......................................................................... _____________ (43)
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Due to Suppliers.................................................................... +____________ (44)
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Due to Affiliates and Subsidiaries......................................... +____________ (45)
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Due to Officers...................................................................... +____________ (46)
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Due to Employees ................................................................. +____________ (47)
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Advances and Deposits on Livestock.................................... +____________ (48)
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Taxes..................................................................................... +____________ (49)
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Demand Notes Payable ......................................................... +____________ (50)
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Notes, Mortgages, and Bonds Due within One Year............. +____________ (51)
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Other (specify) ...................................................................... +____________ (52)
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Total Payables, Accruals And Other Liabilities ....................
____________ (53)
♦ Total Current Liabilities ..................................................................................... $_____________ (54)

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Long-Term Liabilities
♦ Notes, Mortgages, and Bonds Payable (excluding
payments due within one year, included in line 51) ...................... ____________ (55)
♦ Less Sinking Fund......................................................................... (___________) (56)
♦ Other (specify) .............................................................................. ____________ (57)
♦ Total Long-Term Liabilities................................................................................ _____________ (58)

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Total Liabilities (add lines 54 and 58)..................................................................................................

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Net Worth
♦ If the Reporting Firm is Incorporated:
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Capital Stock – Preferred & Common……………………………………………____________ (60)
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Paid-In Capital (+)… ..................................................................................... …..____________ (61)
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Retained Earnings (+)…………………………………………………………….____________ (62)
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Treasury Stock (-) .......................................................................................... …. ____________ (63)
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Incorporated Net Worth…………………………………………………………………... ______________(64)
♦ If the reporting firm is NOT incorporated:
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Owner’s Capital ............................................................................................. _____________ (65)
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Unincorporated Net Worth: ...............................................................................................______________ (66)

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Total Liabilities And Net Worth (if inc. add lines 59 and 64; if uninc. 59 and 66)………………………________________ (67)

$_____________ (59)

Certification: I certify that the balance sheet has been prepared by me or under my direction, and that to the best of
my knowledge and belief, this balance sheet correctly reflects the assets and liabilities of the reporting firm.
68. Date:
69. Title:
70. Signature:
You must print the completed form, sign and date
lines 68 and 70, and mail to the appropriate office
for your state.
Response is required so that financial solvency can be monitored. (See 9 CFR 201.97.)
Return report to appropriate regional office specified in the instructions (P&SP-3410-i).
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid
OMB control number. The valid OMB control number for this information is 0580-0015. The time required to complete this collection is
estimated to average 1 hour per response, including the time to review instructions, search existing data resources, gather the data needed, and
complete and review the information collection.

AUGUST 2007

Form P&SP-3410

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