Appendix 17 FS 6500 24 Financial Statement 508c

United States Department of Agriculture

Prospectus for Campground and Related Granger-Thye Concessions Chequamegon-Nicolet National Forest

Appendix 17: FS-6500-24, Financial Statement

USDA Forest Service

FS-6500-24 (V. 07/2012)

OMB No. 0596-0082

FINANCIAL STATEMENT

(Ref. 36 CFR 223.7(e), 36 CFR 251.54(e)(2), Federal Acquisition Regulation 48 CFR 9.104-1.) INSTRUCTIONS: Forest Service (FS) requires the respondent to provide the most recent fiscal year financial statement. FS may also request the respondent to provide two additional years of financial data, on a case by case basis. If more space is needed to fully answer any item below, attach additional sheets. False or fraudulent financial reporting on this form is subject to a fine or imprisonment under 18 U.S.C. 1001(a). 1. NAME OF CORPORATION, LIMITED LIABILITY COMPANY (LLC.), PARTNERSHIP, OR PROPRIETORSHIP (include any names the organization/firm operated under during past three years and specify the year operated for each name):

2. STATE

INCORPORATED

3. DATE INCORPORATED

4. ADDRESS OF PRINCIPAL PLACE OF BUSINESS (with

ZIP CODE)

5. IF PARTNERSHIP, NAMES OR PARTNERS, AND THEIR PARTNERSHIP INTERESTS

6. NAMES, TITLES, AND ADDRESSES OF CORPORATE OFFICERS AND DIRECTORS, WITH NUMBER OF SHARES

OF STOCK OWNED BY EACH

FULL NAME

TITLE

ADDRESS

SHARES

(Number, Street, City, State, and ZIP CODE)

OWNED

7. REFERENCES (At least three should be given, preferable banks): Full Name

ADDRESS

(Number, Street, City, State, and ZIP CODE)

USDA Forest Service

FS-6500-24 (V. 07/2012)

OMB No. 0596-0082

NOTE: Respondents may submit certified financial statements in lieu of answering PARTS A through C on the next pages. However, respondents must complete either certification statement PART D (1) or PART D (2) at the bottom of the last page.

PART A. BALANCE SHEET

CURRENT YEAR

(MO/DA/YR)

YEAR ENDED

PAST YEAR

(MO/DA/YR)

THIRD YEAR

(MO/DA/YR)

ASSETS

CURRENT ASSETS:

CASH

RECEIVABLES-TRADE

LESS ALLOWANCES FOR DOUBTFUL ACCOUNTS

<

>

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INVENTORIES (LIST MAJOR CATEGORIES):

SUPPLIES AND MISCELLANEOUS

MARKETABLE SECURITIES

PREPAID EXPENSES

SUPPLIES INVENTORY

OTHER CURRENT ASSETS:

TOTAL CURRENT ASSETS

FIXED ASSETS:

LAND

BUILDINGS

MACHINERY AND EQUIPMENT

PLANT

LEASEHOLD IMPROVEMENTS

OTHER

LESS ALLOWANCE FOR DEPRECIATION

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BOOK VALUE-FIXED ASSETS

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USDA Forest Service

FS-6500-24 (V. 07/2012)

OMB No. 0596-0082

OTHER ASSETS:

DEPOSITS-CASH

DEPOSITS-SECURITIES

TOTAL-OTHER ASSETS

TOTAL ASSETS

LIABLIITIES AND OWNER EQUITY

CURRENT

YEAR

CURRENT LIABILITIES:

ACCOUNTS PAYABLE-TRADE

ACCRUED PAYROLL