FSA-2028 Date of Modification 12-31-07
Fld Name /
|
Instruction |
1(a) Month and Day |
Enter the month and day and year this agreement is signed (i.e. March 10, 2006). |
1(b) Name of Debtor |
Enter the legal name of the debtor(s). |
1(c) Mailing Address |
Enter debtor’s complete mailing address, including zip code. |
2(a) Description of Collateral |
Enter a description of the collateral in the space provided. |
2(b)(1) Farms/Other Real Estate Owner |
Enter farm name or landowner name where all crops are or will be grown. |
2(b)(2) Approximate Number of Acres |
Enter the approximate number of acres for land listed in Item 2(b)(1). |
Fld Name /
|
Instruction |
2(b)(3) County and State |
Enter the County and State where the farm(s) listed in Item 2(b)(1) are located. |
2(b)(4) Distance and Directions from Nearest Town |
Enter a brief description of approximate distance and directions from the nearest town or landmark to the farm(s) listed in Item 2(b)(1). |
2(c)(1) State(s) Where Farm… |
Enter the name of the State(s) where the farm and other equipment listed in Items 2(c)(2) through 2(c)(9) is located. |
2(c)(2) Line Number |
Enter a line number for each entry. Line numbers must be sequential, beginning with number 1. |
2(c)(3) Quantity |
Enter the quantity of each kind of equipment. |
2(c)(4) Kind |
Enter the kind of equipment. |
2(c)(5) Manufacturer |
Enter the manufacturer for each piece of equipment. |
2(c)(6) Size and Type |
Enter the equipment's size and type. |
2(c)(7) Condition |
Enter the condition for each piece of equipment (i.e. Excellent, Good, Fair or Poor). |
2(c)(8) Year of Manufacture |
Enter the year the equipment was manufactured. |
2(c)(9) Serial or Model No. |
Enter equipment serial and model number. |
2(c)(10) Fixtures |
Enter description of fixtures and the legal description of the associated real estate. If more space is needed, insert an additional page. This page should be initialed by the debtor. |
2(d)(1) State(s) Where Livestock… |
Enter the State(s) where the livestock or farm products listed in Items 2(d)(2) through 2(d)(9) are located. |
2(d)(2) Line Number |
Enter a line number for each entry. Line numbers must be sequential, beginning with number 1. |
2(d)(3) Quantity |
Enter the quantity of each kind of livestock listed. |
2(d)(4) Kind-Sex |
Enter the kind or sex for the animals listed. |
2(d)(5) Breed |
Enter the breed for the animals listed. |
2(d)(6) Color |
Enter the color for the animals listed. |
2(d)(7) Weight |
Enter the approximate average weight for the animals listed. |
2(d)(8) Age |
Enter the age or age range for the animals listed. |
2(d)(9) Brands or Other Identifi- cation |
Enter description of any brands or other identifying marks for the animals listed. |
2(e) List All Accounts |
List all accounts, deposit accounts, goods, supplies, inventories, investment property, etc., that may serve as security. |
5 Certification |
Read Items 3 and 4 and the certification before signing the form. |
6A Debtor Signature |
Enter legal signature and date the document is executed.
NOTE: If applicable, the debtor(s) will affix their Seal to the form above their signature(s). |
6B Debtor Signature |
Enter legal signature and date the document is executed.
NOTE: If applicable, the debtor(s) will affix their Seal to the form above their signature(s). |
Space provided for additional signatures.
Page
File Type | application/msword |
File Title | INSTRUCTIONS FOR PREPARATION |
Author | cquayle |
Last Modified By | maryann.ball |
File Modified | 2010-07-01 |
File Created | 2010-07-01 |