Form Ssa-7163a-F4 - Supplemental Statement Regarding Farming Activities Of Person Living Outside The Usa Page 2

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7. Give below the following information about livestock, poultry, crops or produce which the family used or
bartered.
PRESENT YEAR
LAST YEAR
AMT. AND KIND OF GOODS
AMT. AND KIND OF GOODS
AMT. USED
AMOUNT
AND/OR SERVICES
AMT. USED
AMOUNT
AND/OR SERVICES
ITEM
ITEM
ON FARM
BARTERED
RECEIVED IN EXCHANGE FOR
ON FARM
BARTERED
RECEIVED IN EXCHANGE FOR
BARTERED GOODS
BARTERED GOODS
8. Give below the following information about other income or payments received from your farming operation (such as
government agricultural program payments, patronage dividends, breeding fees, etc.)
PRESENT YEAR
LAST YEAR
TYPE OF INCOME
AMOUNT RECEIVED
TYPE OF INCOME
AMOUNT RECEIVED
(local currency)
(local currency)
9. Give description and age of farm equipment or machinery you have (such as tractor, wagon, truck, etc.) (If none, show
none.)
10.What animals do you have to work the farm? (If none, show none.)
Form SSA-7163A-F4 (08-2011) EF (08-2011)
PAGE 2

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