5-4759 Assignment of Loan Documents

BIA Form 5-4759
Revised 4/17/01

OMB Control No. 1076-0020
Expires: 12/31/06

ASSIGNMENT OF LOAN DOCUMENTS AND RELATED RIGHTS
_______________________________________________________ (“Lender”) hereby assigns to the Bureau
of Indian Affairs (“BIA”) all rights the Lender has under the loan documents identified on the attached
Exhibit A. The Lender makes this Assignment under the terms of BIA’s Loan Guaranty, Insurance, and
Interest Subsidy Program, 25 U.S.C. §§ 1481 et seq., 1511 et seq., and 25 CFR Part 103 (the “Program”),
upon final payment from BIA for the Lender’s Claim for Loss under the following instrument(s):

BIA Loan Guaranty Certificate Number ______________
BIA Loan Insurance Agreement Number ______________, with respect to the loan identified on
Exhibit A.

The persons signing below represent to BIA that they have due authorization and power to sign this
Assignment in the capacity stated and to bind the Lender. The Lender also represents to BIA that
immediately prior to making this Assignment, it was the sole owner of the Lender’s interest in the documents
and rights assigned hereby, or the duly authorized agent of all such parties.
This Assignment is binding on the Lender, as well as its officers, directors, employees, agents, heirs,
executors, administrators, assigns, successors in interest, predecessors in interest, and anyone else claiming
by, through or under the Lender. In the event any claim, demand, or action is brought or pursued by, through,
or under the Lender in contradiction of this Assignment, the Lender agrees to indemnify BIA and hold it
harmless with respect to the claim, demand or action.
Lender:______________________________
ABA No.:____________________________
By:__________________________________
Its:__________________________________
Paperwork Reduction Act Statement: This form is covered by the Paperwork Reduction Act. It is used to establish the respective
rights and responsibilities of the respondent and the Federal government. The information is provided by respondents to obtain or
retain a benefit. In compliance with the Paperwork Reduction Act of 1995, as amended, the collection has been reviewed by the
Office of Management and Budget and assigned a number and an expiration date. The number and expiration date are at the top right
corner of the form. An agency may not sponsor or conduct, and a person is not required to respond to, a request for information
collection unless it displays a currently valid OMB Control Number.
Burden Estimate: The public reporting burden is estimated to average 2 hours per respondent. This includes the time needed to
understand the requirements, gather the information, complete the form, and submit it to BIA. Comments regarding the burden or
other aspects of the form may be directed to the Information Collection Control Officer, Bureau of Indian Affairs, 1849 C Street NW,
MS - 4603 MIB, Washington, DC 20240. Note: comments, names and addresses of commentators are available for public review
during regular
business hours. If you wish us to withhold this information, you must state that prominently at the beginning of your comment. We
will honor your request to the extent allowable by law.
Privacy Act Statement (5 U.S.C. 552(a)): The authority for collecting this information is 25 U.S.C. 1511. The information will be
used to administer the interest subsidy provisions relating to the Loan Guaranty and Insurance Program, 25 U.S.C. 1481 et seq.
Disclosures of this information may be made to consumer reporting agencies; Federal, State, or local governments; law enforcement
personnel responsible for investigating or prosecuting violations of, or for enforcing or implementing, statutes, rules, regulations,
orders, or licenses; the U.S. Department of Justice; courts of law or adjudicative bodies; Members of Congress; the U.S. Department
of the Treasury; and other Federal agencies responsible for collecting debts or detecting and eliminating fraud.

BIA Form 5-4759
Revised 4/17/01

OMB Control No. 1076-0020
Expires: 12/31/06

Exhibit A
Loan Documents
The following loan documents are all subject to the Assignment of Loan Documents and Related
Rights, to which this Exhibit is attached. Except as otherwise noted, the loan documents are all dated
___________________, 20____:

Note from Lender to _____________________________________________________________
(“Borrower”) in the original principal amount of $___________________.

Deed of Trust/Mortgage from Borrower to Lender, recorded on ____________________, 20_____ at
Book _______, Page ______ in the ________________________________ (Recorder’s Office).

Security Agreement from Borrower to Lender.

Financing statement from Borrower to Lender, recorded on __________________, 20_____ at Book
_______, Page ______ in the ______________________________________ (Recorder’s Office).

Guarantee from ______________________________________________ (“Guarantor”) to Lender.

Other (specify) ___________________________________________________________________
______________________________________________________________________________.

Other (specify) ___________________________________________________________________
______________________________________________________________________________.

Other (specify) ___________________________________________________________________
______________________________________________________________________________.

Other (specify) ___________________________________________________________________
______________________________________________________________________________.