LGC10 Other: Certificate of Loan Guarantee Issued by Dept

IA Form LGC10 OMB Control No. 1076-0020

Revised March 2010 Expires _______________

Department of the Interior

Loan Guarantee Certificate

No. __________________

Date:_______________, 20___

Lender: __________________________________

Address: __________________________________

__________________________________

__________________________________

Borrower: __________________________________

Address: __________________________________

__________________________________

__________________________________

Loan Guarantee Percentage: _______%

Original Loan Principal Amount: $__________________________

(Exclusive of amounts potentially added pursuant to 25 CFR §§ 103.8, 103.34, or 103.36.)

Lender’s Internal Loan Number: ___________________________

Interest Subsidy, if any:  Approved  Not Approved

The Department of the Interior guarantees payment to the Lender of the listed percentage of any loss of principal, accrued interest, and authorized charges the Lender sustains on the identified loan. This guarantee is subject to the provisions of the Loan Guarantee, Insurance and Interest Subsidy Program, 25 U.S.C. §§ 1481 et seq., 1511 et seq., and 25 CFR Part 103, the Conditions of Approval attached to this Loan Guarantee Certificate as “Exhibit A,” and any subsequent modifications to the loan or to this guarantee authorized and approved by the Department. To constitute evidence of the Department’s guarantee, this Loan Guarantee Certificate must have specific Conditions of Approval attached.

The Lender may sell the loan and this Loan Guarantee Certificate in accordance with the requirements of 25 CFR Part 103.

United States Department of the Interior

By: _______________________________

Title: _______________________________