Land Contract Guarantee program and Emergency Equine Loss Loan (EM) Program - Direct Loan Making

Land Contract Guarantee Program and Emergency Equine Loss Loan (EM) Program - Direct Loan Making

FSA2004Ins_12-31-07

Land Contract Guarantee program and Emergency Equine Loss Loan (EM) Program - Direct Loan Making

OMB: 0560-0278

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FSA- 2004 Date of Modification 12-31-2007




AUTHORIZATION TO RELEASE INFORMATION

INSTRUCTIONS FOR PREPARATION

Purpose:

This form is completed by the applicant to authorize employers, financial institutions, and creditors to verify and provide employment, income or other financial information in connection with the submission of an application for a loan or servicing assistance.


Handbook Reference:

3-FLP

Number of Copies:

Original

Signatures Required:

Applicant

Distribution of Copies:

Original in case file.

Automation-Related Transactions: N/A


Please read Items (1) through (4) and the Privacy Act Statement. Applicant must complete Items (5A), (5B), and (5C).


Applicants must complete all Items.

Fld Name /
Item No.

Instruction

(1) – (4)

General

Please read.

(5A)

Name

Enter the applicant’s name.

(5B)

Signature

Enter the applicant’s signature


(5C)

Date

Enter the date the applicant signed.



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File Typeapplication/msword
File TitleTemplate Users: Select the text for each of the instruction components below and type over it without changing the font type,
AuthorPreferred Customer
Last Modified Bymaryann.ball
File Modified2010-07-01
File Created2010-07-01

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