UNITED STATES BANKRUPTCY COURT DISTRICT OF OREGON In re ) ) ) ) ) ) ) ) ) ) Case No. _________________ EX. D-1 FINANCIAL REVIEW OF DEBTOR'S FARMING/FISHING BUSINESS [File With Statement of Financial Affairs in All Chapter 12 Cases; and Chapter 13 Cases If Debtor Earns Any Income From Any Ownership Interest in a FARMING or FISHING Business]
Debtor(s)
(NOTE: ONLY INCLUDE information directly related to the farming/fishing operation. This information is to be from the corporate books where necessary. If an item of Income or Expense does not apply indicate with N/A. Column (2) of this exhibit must be updated and submitted to the Trustee on a quarterly basis.) Cash Basis INDICATE ACCOUNTING METHOD USED: BUSINESS NAME, ADDRESS AND PHONE NUMBER: (1) Previous Calendar Year FARMING/FISHING INCOME: 1. Total Income $___________________ 2. Custom Hire Income $___________________ 3. Total Other Income $___________________ 4. Total Government Payments $___________________ 5. Gross Income $ FARMING/FISHING EXPENSES: 6. Chemicals $___________________ 7. Custom Hire $___________________ 8. Equipment Rental $___________________ 9. Feed $___________________ 10. Fertilizers $___________________ 11. Fuel $___________________ 12. Insurance $___________________ 13. Interest $___________________ 14. Labor Hired $___________________ 15. Rent/Lease $___________________ 16. Repairs $___________________ 17. Seeds $___________________ 18. Supplies $___________________ 19. Payroll Taxes $___________________ 20. Income/Self Employment Taxes $___________________ 21. Taxes-Other $___________________ 22. Utilities $___________________ 23. Vehicle Expenses $___________________ 24. Veterinary and Medicine $___________________ 25. Other Expenses: ___________________________ $___________________ ___________________________ $___________________ ___________________________ $___________________ ___________________________ $___________________ ___________________________ $___________________ 26. Total Accounts Payable (attach schedule) $___________________ 27. Total Farming/Fishing Expenses $___________________ 28. NET FARMING/FISHING INCOME (line 5 less line 27) $ ESTIMATED AVERAGE NET MONTHLY INCOME EXHIBIT D-1 (10/17/05) Accrual Basis
(2) Current Year to Date $___________________ $___________________ $___________________ $___________________ $ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $
(3) Projected Annual Income and Expense $___________________ $___________________ $___________________ $___________________ $ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $___________________ $ $