________________

Name: ____________________________________ Age: ______________

Name: ____________________________________ Age: ______________

Farm Name: ___________________________________ Years in farming: ___________

Address: _____________________________________________ Phone:(___)___________

Email: _____________________________________________ Fax:(___)_____________

Type of farm: ______________________________________________________

Type of business entity: (Check which applies). ____ Sole proprietor _____ Partnership

_____ C Corporation ______S Corp. _____ Limited liability company _____ LL Partnership

List principal owners/partners/shareholders_____________________________________

________________________________________________________________________

________________________________________________________________________

Is a written copy of the business agreement available? Yes______ No_______

1. Objectives

1. Describe the change(s) you want to make?___________________________________

________________________________________________________________________

________________________________________________________________________

2. What are your goals for this change? ______________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

 

 

3. What is your time frame?________________________________________________

1. Are there any special conditions or other considerations that you would make on this transfer that are important.

II. Background. Describe your farm operation by filling in the blanks as completely as possible.

A. Land (enter acres) Cropland Pasture Woodland Other

Owned _______ _______ _______ _______

Leased from family _______ _______ _______ _______ Leased from outside

Totals _______ _______ _______ _______

Have development rights been sold or donated on this farm?_______________________

_______________________________________________________________________

Are there other easements or restrictions on the farm?_____________________________

________________________________________________________________________

B. Crops: Acres or production area Yield/Acre or value

C. Livestock: Number Yearly Production/Value Owners

D. Major farm buildings: Year Built Condition Market value Owners

E. Residences Occupant Market value Owners

_________________ _______________ ___________ ______________

_________________ _______________ ___________ ______________

_________________ _______________ ___________ ______________

_________________ _______________ ___________ ______________

E. Equipment Market value Owners

Field equipment $___________ _______________

Livestock equipment $___________ _______________

Other _____________ $___________ _______________

Are any key pieces of equipment leased? ______________________________________

Is a current depreciation schedule available? ________Yes _________No

F. Farm labor force: Owner- Family on Non family on Unpaid family

Partners payroll payroll labor

year-round _______ ________ __________ __________

seasonal _______ ________ __________ __________

part-time _______ ________ __________ __________

III. Finances

A. How would you describe the profitability of your farm in the past five years?

B. Are there financial statements available to share? ___________yes _____________no

C. Would you be willing to attach a couple years of financial statements, 1040 F, and balance sheets. ___________yes _____________no

D. Previous estate planning Yes No

• Do principal owners have wills? _____ ______
• Do they have life insurance? _____ ______
• Are there any trusts or potential trusts involved? _____ ______
• Are deeds to the land readily available? _____ ______

IV. In conclusion

A. What are the major challenges in accomplishing your goals?

B. To do list.

3. By my signature, I authorize the people or organizations listed below to discuss the information contained within this report as needed.

________________________________________ date_______________

Name Organization Address Phone

___________________ __________________ ____________ ____________

___________________ __________________ ____________ ____________

___________________ __________________ ____________ ____________

___________________ __________________ ____________ ____________

___________________ __________________ ____________ ____________

___________________ __________________ ____________ ____________

___________________ __________________ ____________ ____________

___________________ __________________ ____________ ____________

Completed by:_______________________________________________

Organization_________________________________________________