Form Exhibit D-1 Financial Review Of Debtor'S ) Farming/fishing Business
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1UNITED 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
Debtor(s)
) Interest in a FARMING or FISHING Business]
(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.)
INDICATE ACCOUNTING METHOD USED:
Cash Basis
Accrual Basis
BUSINESS NAME, ADDRESS AND PHONE NUMBER:
(1)
(2)
(3)
Previous Calendar
Current Year to
Projected Annual
Year
Date
Income and Expense
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)
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