P&SP 7002 Supplemental Balance Sheet Special Report

					For P&SP Use Only									P&SP Bar Code Only
U.S. Department of Agriculture					SUPPLEMENTAL BALANCE SHEET SPECIAL REPORT
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 appropriate P&SP regional office. See separate instructions for complete information about this report.
Stockyards
Program
									GENERAL INFORMATION - SECTION 1
101			Date of Report (mm/dd/yy)
103			Legal Business Name
104			Business Name (dba)
105			Mailing Address
106			City, State, Zip
107			Telephone Number
108			Fax Number
										BALANCE SHEET - SECTION 2
			Include values only for the reporting entity.
Assets
	Current Assets
		Cash (Enter overdrafts under Current Liabilities - line 230)																	201	$
		Overage in analysis of Custodial Bank Account (Enter shortages under Current Liabilities - line 231)																	202	$
		Temporary Cash Investments (Marketable Securities, Certificates
			of Deposit, Commercial Paper, etc.)																203	$
		Accounts Receivable (Due in 1 Year or Less)
			From Sources Not Related to Company											204	$
			From Sources Related to Company											205	$
			Subtotal											206	$
			Less Allowance for Doubtful Accounts											207	$
		Total Accounts Receivable (line 206 less 207)																	208	$
		Notes and Loans Receivable (Portion due in 1 Year or Less)
			From Sources Not Related to Company											209	$
			From Sources Related to Company											210	$
		Total Notes and Loans Receivable																	211	$
		Inventory
			Livestock											212	$
			Meat and Meat Food Products											213	$
			Other Inventory											214	$
		Total Inventory																	215	$
		Advances made on Livestock and Meat																	216	$
		Other Current Assets																	217	$
	Total Current Assets																		218	$
Your response to this form is required under the Packers and Stockyards Act of 1921, as amended and supplemented (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 5 hour per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection.
Balance Sheet, Assets, continuation.
		Investments
			Subsidiaries and Affiliated Companies											219	$
			Stock, Bonds, and Real Estate Not Used in this Business											220	$
		Total Investments																	221	$
		Fixed Assets
			Land											222	$
			Property, Plant, & Equipment (Net of depreciation and amortization)											223	$
		Total Fixed Assets																	224	$
		Other Assets
			Accounts and Notes Receivable (Due after 1 year)
			From sources not related to company											225	$
			From sources related to company											226	$
			All other Assets											227	$
		Total Other Assets																	228	$
Total Assets																			229	$
Liabilities
	Current Liabilities
		Bank Overdraft on Non-Custodial Accounts																	230	$
		Shortage in Analysis of Custodial Bank Account																	231	$
		Accounts Payable
			Livestock Purchases											232	$
			Meat Product Purchases											233	$
			Other Paybles to Sources Not Related to Company											234	$
			Other Payables to Sources Related to Company											235	$
		Total Accounts Payable																	236	$
		Notes and Loans Payable (Demand notes and portion of long-term notes due in 1 year or Less)
			To Sources Not Related to Company											237	$
			To Sources Related to Company											238	$
		Total Notes and Loans Payable																	239	$
		Other Current Liabilities																	240	$
	Total Current Liabilities																		241	$
	Long-Term Liabilities (Due after 1 Year)
		Notes, Mortgages and Payables due after 1 year
			To sources not related to company											242	$
			To sources related to company											243	$
	All Other Liabilities																		244	$
	Total Long-Term Liabilities																		245	$
Total Liabilities																			246	$
Owner's Net Worth
	If Unincorporated
			Owner's Net Worth											247	$
	If Incorporated
			Capital stock and other contributed capital											248	$
			Retained Earnings											249	$
			Incorporated Net Worth											250	$
Total Net Worth																			251	$
Total Liabilities and Net Worth (Equals Total Assets)																			252	$
									FINANCING INFORMATION - SECTION 3
301			Is the registrant liable for any contingent liabilities? If Yes, give brief explaination on line 302.													Yes		No
302
303			At the end of the reporting period, were Accounts Receivable and/or Inventories, or any part thereof, pledged or assigned as collateral under a financing or loan agreement? (If Yes, complete following questions in section)																	Yes		No
			Report financial lending institutions having security interests in lines 304-308 (add addition sheets if more than one)
304			Name of Institution
305			Mailing Address
306			City, State, Zip
307			Contact Person
308			Contact's Number
309			Are Inventories collateralized under the agreement?															Yes		No
310			Are Accounts Receivable collateralized under the agreement?															Yes		No
311			Enter borrowing limit under the agreement														$
312			Enter borrowing payable as of the end of the reporting period														$
313			Are any company owners, directors, officers or stockholders named as a guarantor under the agreement?															Yes		No
314			If company is a subsidiary of another, is the Parent Company named as a guarantor under the agreement?															Yes		No
			Restrictions or covenants under financing or loan agreement
315			Minimum cash balance to be maintained on deposit														$
316			Minimum working capital to be maintained.														$
317			Other (describe)
										CERTIFICATION - SECTION 4
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.
401 Print Name												402 Signature (Must be signed by an owner, partner, officer, of managing member)
403 Phone Number								404 Date				405 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.