P&SP 3003 Annual Report of Market Agency - SOC

Business Entity ID Number						For P&SP Use Only								P&SP Bar Code Only
U.S. Department of Agriculture									ANNUAL REPORT OF MARKET AGENCY SELLING ON COMMISSION
Grain Inspection,																			Indicate your preference to submit forms electronically, or by paper copy
Packers and Stockyards
Administration																			Electronic Filing
																			Manual Filing
Packers and
Stockyards					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.
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
111			E-Mail Address										112		Web Address
									ORGANIZATIONAL STRUCTURE - SECTION 2
			List owners, officers, partners, and 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 livestock-meat sector?												Yes		No
			If line 210 is yes, then provide the names of businesses that you own or control and percentage of control in items 211-214
			a. Name of Business																	b. Percentage of Control
211
212
213
214
Your response to this form is required under 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 2 hour per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection.
								SOC ACTIVITY (CLAUSE 1 BOND) - SECTION 3
301			Number of public sale days covered by this report
			Livestock Sold at Market					a. Cattle & Calves			b. Hogs			c. Sheep & Goats			d. Horses & Mules			e. Total (a+b+c+d)
302			Livestock consigned by others to your market (number of head)
303			Livestock consigned by you to your market (number of head)
304			Total livestock consigned to your market (number of head)
305			Gross value of livestock sold on commission					$			$			$			$			$
							DEALER AND BOC OPERATIONS (CLAUSE 2 BOND) - SECTION 4
			Livestock Dealer Activity					a. Cattle & Calves			b. Hogs			c. Sheep & Goats			d. Horses & Mules			e. Total (a+b+c+d)
401			Cost of livestock purchased on a dealer basis for registrant's account					$			$			$			$			$
402			Number of head of livestock purchased on a dealer basis for registrant's account
			Livestock Bought on Commission					a. Cattle & Calves			b. Hogs			c. Sheep & Goats			d. Horses & Mules			e. Total (a+b+c+d)
403			Cost of livestock bought on commission for the account of others regardless of who paid for the livestock.					$			$			$			$			$
404			Number of head of livestock bought on commission for the account of others regardless of who paid for the livestock.
405			Number of days business conducted, as a livestock dealer/order buyer, during the reporting year
406			Livestock Dealer Activity					a. First Quarter				b. Second Quarter				c. Third Quarter				d. Fourth Quarter
			Cost of livestock purchased as a dealer, per quarter					$				$				$				$
407			Livestock Bought on Commission					a. First Quarter				b. Second Quarter				c. Third Quarter				d. Fourth Quarter
			Cost of livestock bought on commission, per quarter					$				$				$				$
408			Total Cost of Livestock Purchased (should be equal to 401e plus 403e)															$
								CLEAREE AND CLEAROR DESIGNATIONS - SECTION 5
501			Are you a clearee (cleared by another business for your livestock purchases)?											Yes		No
502			If you checked yes in item 501, provide the name of the clearing agent:
503			Are you a clearor (provide clearing services for clearees)?										Yes		No	If yes provide information for lines 504-512
			Clearee's Name as Registered											Gross Value of Livestock Purchased
504														505	$
506														507	$
508														509	$
510														511	$
			Total Livestock Purchases of all Clearees											512	$
						ANALYSIS OF CUSTODIAL BANK ACCOUNT FOR SHIPPERS' PROCEEDS - SECTION 6
601			Bank Statement as of (Date)
602			Balance per Bank Statement											$
603			Deposits in Transit (in mail or bank, but not on statement)											$
604			CD's and Savings Accounts designated as Custodial Funds											$
605			Proceeds on Hand											$
606			Proceeds Receivables											$
607				Total Debits										$
608			Outstanding Checks and Drafts which have not Cleared Bank											$
609			Proceeds Due Consignors of Livestock for which no Checks were issued											$
610			Expense Items incident to Sales remaining in Account											$
611				Total Credits										$
612				Overage in account (Debits exceed Credits) - Enter on line 702										$
613				Shortage in account (Credits exceed Debits) - Enter on line 719										$
									BALANCE SHEET - SECTION 7
			Include values only for the reporting entity.
Assets
	Current Assets
701			Cash on Hand and in Non-Custodial Bank Accounts (Enter overdrafts under Current Liabilities - Line 718)																	$
702			Overage in Analysis of Custodial Bank Account (From Line 612)																	$
703			Temporary Cash Investments (Marketable Securities, Certificates of Deposit, Commercial Paper, etc.)																	$
	Accounts Receivable (Due in 1 Year or Less)																			$
704			From Sources Not Related to Company											$
705			From Sources Related to Company											$
706			Total Accounts Receivable																	$
707			Notes and Loans Receivable (Portion due in 1 Year or Less)																	$
	Inventory
708			Livestock Inventory																	$
709			Other Inventory																	$
710			Total Inventory																	$
711			Other Current Assets																	$
712				Total Current Assets																$
	Non Current Assets
713			Investments																	$
714			Property, Plant & Equipment (Net of Depreciation and Amortization)																	$
715			Other Long-Term Assets																	$
716				Total Long-Term Assets																$
717				Total Assets																$
Liabilities and Net Worth
Liabilities
	Current Liabilities
718			Bank Overdraft in Non-Custodial Bank Accounts																	$
719			Shortage in Analysis of Custodial Bank Account (from line 613)																	$
			Accounts Payable																	$
720			Livestock Payables																	$
721			Other Payables to Sources Not Related to Company																	$
722			Other Payables to Sources Related to Company																	$
723			Total Accounts Payable																	$
724			Notes and Loans Payable (Demand Notes and Portion of Long-Term Notes due in 1 Year or Less)
725			Other Current Liabilities																	$
726				Total Current Liabilities																$
	Non-Current Liabilities
727			Long-Term Liabilities (Due After 1 Year)																	$
728				Total Liabilities																$
729				Total Net Worth																$
730				Total Liabilities and Net Worth (Equals Total Assets)																$
									INCOME STATEMENT - SECTION 8
Income Statement
801			Selling Commissions of Market																	$
802			Gross Dealer Profit (+) or Loss (-)																	$
803			Buying Commission																	$
804			Other Income																	$
805				Total Income																$
806				Total Expenses																$
807				Net Profit (+) or Loss (-)																$
										CERTIFICATION - SECTION 9
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.
901 Print Name												902 Signature (Must be signed by a person listed on 201-205)
903 Phone Number								904 Date				905 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.