P&SP 3610 Supplemental Balance Sheet - Live Poultry Dealers

OMB Control No. 0580-0015
1. Balance Sheet as of (give date):
U.S. DEPARTMENT OF AGRICULTURE
GRAIN INSPECTION, PACKERS AND
STOCKYARDS ADMINISTRATION
PACKERS AND STOCKYARDS PROGRAM

SUPPLEMENTAL BALANCE SHEET
LIVE POULTRY DEALER

2. Name and Address (include ZIP code)

The Packers and Stockyards Act provides in part that: “Any person who shall willfully make, or cause to be made, any false entry or statement of fact in any report required to be
made under this Act shall be deemed guilty of an offense against the United States and shall be subject, upon conviction in any court of the United States of competent jurisdiction,
to a fine of not less than $1,000 nor more than $5,000, or to imprisonment…”

SECTION 1-ASSETS
A. Current Assets:
Cash on Hand and in Banks…………………………………………………………..………..…….….. $___________________ (3)
(enter overdraft on the reverse under Current Liabilities)
Temporary Cash Investments ……………………………………………………….............………….. ___________________ (4)
(marketable securities, certificates of deposit, commercial paper, etc.)
Accounts Receivable
From Trade……………………………………………….… $___________________(5)
From Others (owners, officers, employees, subsidiaries.
and affiliated companies)…………………………..…. ___________________(6)
Subtotal.……………………………………………….……. ___________________(7)
Less Allowance for Doubtful Accounts…………………...……….…… ___________________(8)
Notes and Loans Receivable (due within 1 year)
Due from Subsidiaries and Affiliated Companies…………

___________________(9)

___________________(10)

Due from Owners, Directors, Officers, Stockholders……...

___________________(11)

Due from Others……………………………….…….…….

___________________(12)

Inventories:
Live Poultry (Purchases and Growout Contracts)………...

___________________(14)

Poultry Products……………………………………………

___________________(15)

Other Inventories…………………………………………..

____________________(16)

___________________(13)

__________________(17)

Advances Made on Live Poultry……………………………………………………….…..…………..

__________________(18)

Prepaid Expenses (rent, insurance, etc.)…………………………………………………..….……….

__________________(19)

Other Current Assets……………………………………………………………………..…..………...

__________________(20)

Total Current Assets
$__________________(21)
B. Investments:
Subsidiaries and Affiliated Companies………………………………………………………..……… ___________________(22)
Other……………………………………………………………………………………………..…….

___________________(23)
Total Investments __________________(24)

C. Fixed Assets:
Land…………………………………………………………………………………………..…..…..
Buildings, Equipment, and Other Fixed Assets……………............

___________________ (26)

Less Accumulated Depreciation …………………………….…….

_____ ______________(27)

___________________(25)
___________________(28)
Net Fixed Assets ___________________(29)

D. Other Assets:
Notes Receivable (due after 1 year)………………………………………..…..……..……………..

___________________(30)

Goodwill, Patents, Trade-marks (less amortization)…………………………………………………

___________________(31)

Other Assets (specify) ___________________________________________________________

___________________(32)

___________________________________________________________________________

___________________(33)
Total Other Assets ___________________(34)
Total Assets ___________________(35)

AUGUST 2007

Form P&SP-3610

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SECTION 2-LIABILITIES AND OWNER’S EQUITY
A. Current Liabilities
Bank Overdraft (per books)……………………………………………………………………….….. $____________________(36)
Accounts Payable—Live Poultry (Purchases and Growout Contracts)...............................…............

____________________(37)

Accounts Payable—Other………………………………………………………………….………….. ____________________(38)
Notes and Loans Payable (due within 1 year)
Due to Banks, Financing and Lending Companies…….… $___________________(39)
Due to Subsidiaries and Affiliated Companies…………… ___________________(40)
Due to Owners, Directors, Officers, Stockholders……….. ___________________(41)
Due to Others………………………………………………………… ___________________ (42)

__________________(43)

Accrued Liabilities……………………………………………………………….…………………… __________________(44)
Accrued Federal and Other Income Taxes………………………………………………………...…. __________________ (45)
Accrued Other Taxes……………………………………………………………………………...….. __________________ (46)
Other Current Liabilities………………………………………………………………………...……. __________________(47)
Total Current Liabilities $___________________(48)
B. Long-Term Liabilities (due after 1 year):
Due to Subsidiaries and Affiliated Companies……………………………………………………….. ___________________(49)
Due to Owners, Directors, Officers, Stockholders…………………………………………………..... ___________________ (50)
Due to Others………………………………………………………………………………………...... ___________________(51)
Total Long-Term Liabilities ___________________(52)
Total Liabilities

__________________(53)

C. Deferred Income Taxes……………………..……………………………………………………………………………………..__________________(54)
D. Owner’s Equity
If Incorporated:
Capital Stock—Preferred and Common…………………………………………..……….

___________________(55)

Additional Paid-In Capital………………………………………………………..………..

___________________(56)

Retained Earnings……………………………………..… ___________________(57)
Less Cost of Treasury Stock…………………...…….. ___________________(58)
Total Retained Earnings………………………………………………………..
If Unincorporated
Owner’s Capital—Net of Withdrawals……………………………………………………..

___________________(59)
___________________(60)
Total Owner’s Equity

_________________(61)

Total Liabilities and Owner’s Equity _________________(62)
E. Contingent Liabilities (explain below)
Remarks:

Certification: I certify that this balance sheet has been prepared by me or under my direction, and that to the best of my knowledge and belief, said balance
sheet correctly reflects the assets and liabilities of the reporting firm.

___________________
63. Date

______________________________________
64. Title

__________________________________________________________
65. Signature (Sole Proprietor, Partner, Officer of a Corporation, or a
Person of Authority if an LLC)
Return Completed Report to appropriate regional office, see separate instructions for information.
Response is required by law to ensure compliance with the Packers and Stockyards Act, 1921, as Amended and Supplemented. Failure to report after notice of
default will result in forfeiture to the United States the sum of $110 for each and every day of the continuance of such failure.
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 8 hours 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

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