P&SP 3002 Annual Report of Live Poultry Dealers

					For P&SP Use Only									P&SP Bar Code Only
U.S. Department of Agriculture					ANNUAL REPORT OF LIVE POULTRY DEALERS
Grain Inspection,
Packers and Stockyards
Administration
Packers and					Instructions: If an item's value is zero, enter "0". If an item does not apply, enter "NA". Upon completion please verify that all items have been answered. Return completed form to the P&SP Central Reporting Unit. See instructions for information about this report.
Stockyards
Program
										GENERAL INFORMATION - SECTION 1
101			Reporting Period (mm/dd/yy)			a. from									b. to
102			Legal Business Name
103			Business Name (dba)
104			Mailing Address
105			City, State, Zip
106			Physical Address
107			City, State, Zip
108			Contact Name
109			Telephone Number
110			Fax Number
										ORGANIZATIONAL STRUCTURE - SECTION 2
			List owners, officers, partners, and managing members in control of this business
			a. Name									b. Title							c. Percentage Ownership
201
202
203
204
205
206			Type of organization:		Individual			Partnership			Corporation			L.L.C.		L.L.P.	Co-op		Association			Other
207			Is this the same organization type reported last year?									Yes		No
208			Is this business owned or controlled by another business entity?									Yes		No
209			If line 208 is yes, identify the owner/controlling business name and address
210			Does this business own or control other businesses within the poultry sector?												Yes		No
			If line 210 is yes, then provide the names of businesses that you own or control and percentage of control it items 211-214
			a. Name of Business																	b. Percentage of Control
211
212
213
214
Your response to this form is required as defined in the Packers and Stockyards Act of 1921 (9 CFR 201.97 and 7 U.S.C. 181-229). 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 information collection is estimated to average 7 hour per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection.
										OPERATING INFORMATION - SECTION 3
Activities engaged in (check all that apply).
301			Producing poultry under growout contracts for slaughter
302			Producing poultry under marketing agreements for slaughter
303			Producing poultry under either of the above growing arrangements for sale to another for slaughter
304			Producing poultry under either of the above growing arrangements for slaughter by a custom slaughterer
305			Custom poultry slaughterer
306			Buying live poultry for slaughter (e.g. spent fowl plant)
307			Buying live poultry for slaughter by a custom slaughterer
308			Buying live poultry for resale to a slaughterer
309			Buying live poultry for resale to a live bird market
Input and product markets.
310			Enter the number of active grow-out contracts and marketing agreements on the last day of this reporting period.
311			Was any poultry purchased or obtained under growing arrangements from outside the state in which it was slaughtered or sold?																		Yes		No
312			Was any live poultry sold outside the state in which it was bought or obtained under growing arrangement?																		Yes		No
313			Was any poultry meat sold outside the state in which the poultry was slaughtered?																		Yes		No
Location of activities (attach additional page if needed).
314			a. Slaughter Facility Name			b. Address: Street, City, State							c. Phone		d. Feed Mill Address: City State							e. Phone
315
316
317
318
319
320
321
322
323
324
325
326
327
										TOTAL SLAUGHTER - SECTION 4
			Total slaughter							a. Chickens (Head)					b. Turkeys (Head)					c. Other (Head)
401			Poultry grown under growout contracts
402			Poultry grown under marketing agreements
403			Poultry grown by the company (e.g. company owned farms)
404			Live poultry purchased
405			Total poultry procured (sum lines 401 to 404)
406			Live poultry sold
407			Total poultry custom slaughtered by you for others
408			Total slaughter (line 405 minus 406 plus 407)
										FINANCIAL INFORMATION - SECTION 5
501			Were any portion of your Accounts Receivable and/or Inventories committed as collateral at the end of the reporting period?																		Yes		No
			Enter the name and location of the bank you use most often for poultry payments
502			Bank Name
503			Physical Address
504			City, State, Zip
										BALANCE SHEET - SECTION 6
			Include assets, liabilities, and net worth only for the reporting entity.
Assets
	Current Assets
		Cash																	601	$
		Accounts Receivable (Due in 1 Year or Less)																	602	$
		Notes and Loans Receivable (Portion due in 1 Year or Less)																	603	$
		Inventories																	604	$
		Other Current Assets																	605	$
	Total Current Assets																		606	$
	Total Long Term Assets																		607	$
Total Assets																			608	$
Liabilities and Net Worth
Liabilities
	Current Liabilities
		Accounts Payable												609	$
		Other Current Liabilities												610	$
	Total Current Liabilities																		611	$
	All Other Liabilities													612	$
Total Liabilities																			613	$
Total Net Worth																			614	$
Total Liabilities and Net Worth (Equals Total Assets)																			615	$
										INCOME STATEMENT - SECTION 7
			This section must be completed on this form. Include values only for the reporting entity.
Income Statement
	Net Sales (Gross sales less sales returns and allowances)																		701	$
	Cost of Sales
			Opening Inventory						702	$
			Live Poultry Purchases						703	$
			Poultry Grow-outs						704	$
			Other Purchases						705	$
			Subtotal (sum lines 702 through 705)											706	$
			Closing Inventory											707	$
	Total Cost of Sales (line 706 less 707)																		708	$
	Gross Profit																		709	$
	Operating Expenses
			Manufacturing Expenses											710	$
			General and Administrative											711	$
			Depreciation and Amortization											712	$
	Total Operating Expenses																		713	$
	Operating Income or Loss																		714	$
	Adjustments to Operating Income																		715	$
Earnings Before Income Taxes																			716	$
										CERTIFICATION - SECTION 8
Under the Packers and Stockyards Act any person who willfully makes, or causes any false entry or statement of fact in this report shall be deemed guilty of offense against the United States, and be subject to a fine of $1,000 to $5,000, or to imprisonment for a term of not more than 3 years, or to both fine and imprisonment.
I certify that this report has been prepared by me or under my direction, and to the best of my knowledge and belief correctly reflects reporting entity operations.
801 Print Name												802 Signature (Must be signed by a person listed on 201-205)
803 Phone Number								804 Date				805 Title
Submitted information is confidential (9 CFR 201.96). Failure to report will result in forfeiture to the United States $110 per day until report receipt 7 (U.S.C. 222).
The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual’s income is derived from any public assistance program. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at (202) 720-2600 (voice and TDD). To file a complaint of discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.