FINANCIAL STATEMENT
(Ref. 36 CFR 223.7(e), 36 CFR 251.54(e)(2), Federal Acquisition Regulation 48 CFR 9.104-1.)
INSTRUCTIONS: Forest Service (FS) requires the respondent to provide the most recent fiscal year financial statement.  FS may also request the respondent to provide two additional years of financial data, on a case by case basis.  If more space is needed to fully answer any item below, attach additional sheets.
	
1.	NAME OF CORPORATION, PARTNERSHIP, OR PROPRIETORSHIP (include any names the organization/firm operated under during past three years and specify the year operated for each name):        
	
2.	STATE INCORPORATED
      
	3.  DATE INCORPORATED
     	4. ADDRESS OF PRINCIPAL PLACE OF BUSINESS (with ZIP CODE)        	
5. IF PARTNERSHIP, NAMES OR PARTNERS, AND THEIR PARTNERSHIP INTERESTS       

6. NAMES, TITLES, AND ADDRESSES OF CORPORATE OFFICERS AND DIRECTORS, WITH NUMBER OF SHARES OF STOCK OWNED BY EACH	
FULL NAME	TITLE	ADDRESS
(Number, Street, City, State, and ZIP CODE)	SHARES OWNED	
     	     	     	     	
     	     	     	     	
	     	     	     	
	     	     	     	
	     	     	     	
	     	     	     	
	     	     	     	
	     	     	     	
	     	     	     	
	     	     	     	
	     	     	     	
7.	REFERENCES (At least three should be given, preferable banks):	
Full Name	ADDRESS
(Number, Street, City, State, and ZIP CODE)	
     	     	
     	     	
     	     	

NOTE: Respondents may submit certified financial statements in lieu of answering PARTS A through C on the next pages.  However, respondents must complete either certification statement PART D (1) or PART D (2) at the bottom of the last page.

PART A. BALANCE SHEET   	
	CURRENT YEAR
(MM/DD/YYYY)	PAST YEAR
(MM/DD/YYYY)	THIRD YEAR
(MM/DD/YYYY)	
YEAR ENDED	                                                                                                                                                                                                                                                                           	              	           	
ASSETS				
CURRENT ASSETS:	     	     	     	
CASH	     	     	     	
RECEIVABLES-TRADE	     	     	     	
LESS ALLOWANCES FOR DOUBTFUL ACCOUNTS	<     >	<>	<       >	
	     	     	     	
INVENTORIES (LIST MAJOR CATEGORIES):	     	     	     	
     	     	     	     	
     	     	     	     	
	     	     	     	
SUPPLIES AND MISCELLANEOUS	     	     	     	
MARKETABLE SECURITIES	     	     	     	
	     			
PREPAID EXPENSES				
SUPPLIES INVENTORY				
				
OTHER CURRENT ASSETS:				
     				
     				
	     		     	
TOTAL CURRENT ASSETS	     	     		
FIXED ASSETS:		     		
LAND		     		
BUILDINGS		     		
MACHINERY AND EQUIPMENT		     		
PLANT		     		
LEASEHOLD IMPROVEMENTS		     		
OTHER       		     		
		     	     	
LESS ALLOWANCE FOR DEPRECIATION	<     >	<>	<       >	
BOOK VALUE-FIXED ASSETS	     	     		
OTHER ASSETS:	     	     		
DEPOSITS-CASH	     	     		
DEPOSITS-SECURITIES	     	     		
	     	     		
TOTAL-OTHER ASSETS	     	     		
TOTAL ASSETS	     	     		

 	
LIABLIITIES AND OWNER EQUITY	CURRENT YEAR	PAST YEAR	THIRD YEAR	
CURRENT LIABILITIES:	     			
ACCOUNTS PAYABLE-TRADE	     			
ACCRUED PAYROLL	     			
ACCRUED PAYROLL TAXES AND INSURANCE	     			
NOTES PAYABLE	     		     	
INCOME TAXES-CURRENT	     			
OTHER TAXES	     		     	
CURRENT PORTION OF LONG-TERM DEBT	     		     	
OTHER CURRENT LIABILITIES (SPECIFY):	     		     	
     	     			
     	     		     	
     	     			
TOTAL CURRENT LIABILITIES	     	     	     	
OTHER LIABILITIES:				
DEFERRED INCOME TAXES	     	     	     	
LOANS FROM OFFICERS/PARTNERS	     		     	
LONG-TERM OBLIGATIONS-LESS CURRENT AMOUNT	     		     	
     	     		     	
     	     		     	
     	     		     	
TOTAL OTHER LIABILITIES	     		     	
				
TOTAL LIABILITIES	     	     	     	
OWNER EQUITY:	     	     	     	
CAPITAL STOCK OUTSTANDING	     	     	     	
RETAINED EARNINGS (DEFICIT)	     	     	     	
	     	     	     	
PARTNERS' INVESTMENT (DEFICIT)	     	     	     	
     	     	     	     	
     	     	     	     	
TOTAL OWNER EQUITY	     	     	     	
TOTAL LIABILITIES AND OWNER EQUITY	     	     	     	

PART B. SUPPLEMENTAL DATA 	
THIS STATEMENT IS ON THE-CASH BASIS       ACCRUAL BASIS      	
INVENTORIES ARE-LIFO       FIFO       COST OR MARKET WHICHEVER IS LOWER 	
NAMES OF CONTRACTORS OR SUB-CONTRACTORS USED (IF ANY):      	
PART C. INCOME STATEMENT                                                       CURRENT YEAR     PAST YEAR         THIRD YEAR	
GROSS SALES				
LESS-RETURNS AND ALLOWANCES	<      >	<        >	<       >  	
NET SALES				
LESS-COST OF GOODS SOLD	<      >	<        >	<       >  	
GROSS PROFIT ON SALES				
LESS-SELLING EXPENSE	<      >	<        >	<       >  	
NET PROFIT (LOSS) ON SALES	     	     	     	
GENERAL EXPENSE:				
OFFICERS SALERIES	     	     	     	
LEGAL AND OTHER PROFESSIONAL EXPENSE	     	     	     	
OFFICE EXPENSE	     	     	     	
TOTAL GENERAL EXPENSE	     	     	     	
NET OPERATING PROFIT (LOSS)				
ADD-OTHER INCOME	     	     	     	
LESS-INTEREST EXPENSE				
INCOME TAXES	<       >	<        >	<      >	
OTHER EXPENSE	<      >	<        >	<       >  	
NET AMOUNT OF OTHER INCOME AND EXPENSE	<       >	<        >	<      >	
NET PROFIT (LOSS) FOR YEAR  	     	     	     	
NOTE: Offers must set forth full, accurate, and complete information as required in this Financial Statement (including any attachments).  The penalty for making false statements in this Financial Statement is prescribed in 18 U.S.C. 1001.	

PART D (1):  CERTIFICATION FOR CORPORATIONS OR PARTNERSHIPS
We, the undersigned, general officers (or members) of        
(insert name of corporation or partnership) being severally sworn, each declares that the above or attached financial statements are true and correct, and that it covers all of the financial affairs of said company (or) firm up to and including the date of       (Month day, year)	
CERTIFYING OFFICIAL'S NAME AND TITLE
     	SIGNATURE (Sign in ink)	DATE	
CERTIFYING OFFICIAL'S NAME AND TITLE
     	SIGNATURE (Sign in ink)	DATE	
SWORN TO AND SUBSCRIBED before me this       day of        
(Month/Year)	(Affix Notary Seal)	
SIGNATURE
	TITLE		
PART D (2). CERTIFICATION FOR INDIVIDUALS
I swear (or affirm) that the above or attached financial statements are true and correct to the best of my knowledge.	
INDIVIDUAL'S NAME AND TITLE
     	SIGNATURE (Sign in ink)	DATE	
SWORN TO AND SUBSCRIBED before me this       day of        
(Month/Year)	(Affix Notary Seal)	
SIGNATURE
	TITLE		
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U.S. GPO: 1996-720-508