FSA 2254 Guaranteed Loan Report of Loss

This form is available electronically.

Form Approved - OMB No. 0560-0155
U.S. DEPARTMENT OF AGRICULTURE
Farm Service Agency

FSA-2254
(12-31-07)

GUARANTEED LOAN REPORT OF LOSS
PART A - BORROWER INFORMATION
1. Borrower's Name

2. Borrower's 9 Digit ID Number

3. State/County Code (For FSA Use Only)

4. Agency Loan Number

5. Report Type Code

6. Loan Type

7. Interest Rate

8A. Lender's Identification Number

9. Lender's Routing Number

10. Lender's Account Number

11. Lender's Account Type

12. Payment Type Code (For FSA Use Only)

13. Payment Date (For FSA Use Only)

14. Date of Deposit (For FSA Use Only)

15. Date of Settlement (For FSA Use Only)

16. Original Loan Amount
$
18. Percent of Guaranteed Portion Held by Lender
%

17. Original Date of Loan

PART B - LOAN INFORMATION
Guaranteed Loan Items:

8B. Lender's Branch Number

Adjustments:

19. Principal Balance

$

35. Funds Being Held

$

20. Accrued Interest Owed

$

36. Income to be Applied to Debt

$

21. Emergency Advances

$

37. Borrower's Debt Payment Ability-Present Value

$

22. Total Guaranteed Loan Items (Items 19+20+21)

$

38. Other Deductions

$

39. Total Adjustments (Items 35+36+37+38)

$

Protective Advances/Legal Expenses:
23. Principal Balance on Protective Advances

$

Loss Guaranteed:

24. Accrued Interest on Protective Advances

$

40. Basic Loss (Items [(22+25+26)-34]-39)

25. Total Protective Advances (Items 23+24)

$

41. Percent of Loss Guarantee

26. Legal Expenses

$

42. Maximum Loss (Items 40x41)

Collateral:

$
%
$

Adjustments to Protective Advances & Interest:

27. Collateral/Proceeds

$

43. Total Protective Advance Payment (Items 25x41)

$

28. Value of Personal and Corporate Guarantee

$

$

29. Total Collateral (Items 27+28)

$

44. Legal Expenses Payment (Items 26x41)
45. Remaining Balance Loss Guarantee
(Items [42-(43+44)]x18)

$

Amount Due Lender or FSA:

Prior Lien/Liquidation Expenses:
30. Liquidation Cost

$

46. Amount Due Lender (Items 43+44+45)

$

31. Prior Liens

$

47. Amount Paid on Estimated Loss

$

32. Unpaid Taxes, Assessments, Ground Rents

$

48. Balance Due Lender (Items 46-47) (If positive)

$

33. Total Prior Liens/Liquidation Exp. (Items 30+31+32)

$

49. Amount of Overpayment (Items 46-47) (If negative)

$

34. Net Collateral (Items 29-33) (If negative, enter 0.00)

$

50. Interest on Overpayment

$

51. Amount due FSA by Lender (Items 49+50)

$

52. Additional Interest Indicator (For FSA Use Only)

YES

53. Principal Portion of Loss Claim (For FSA Use Only)

$

NO

PART C - SIGNATURE
54. Lender Representative Signature

55. Name of Lender

56. Date

58. FSA, SED Signature

59. Date Approved

PART D - FSA USE ONLY
57. FSA Review Official Signature

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable,
sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual's income is derived
from any public assistance program. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program
information (Braille, large print, audiotape, etc.) should contact USDA's TARGET Center at (202) 720-2600 (voice and TDD). To file a complaint of discrimination, write to USDA,
Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal
opportunity provider and employer.

FSA-2254 (12-31-07)

Page 2

60. Comments

NOTE: The following statements are made in accordance with the Privacy Act of 1974 (5 USC 552a): the Farm Service Agency (FSA) is authorized by the Consolidated Farm and
Rural Development Act, as amended (7 USC 1921 et seq.), or other Acts, and the regulations promulgated thereunder, to solicit the information requested on its application
forms. The information requested is necessary for FSA to determine eligibility for credit or other financial assistance, service your loan, and conduct statistical analyses.
Supplied information may be furnished to other Department of Agriculture agencies, the Internal Revenue Service, the Department of Justice or other law enforcement
agencies, the Department of Defense, the Department of Housing and Urban Development, the Department of Labor, the United States Postal Service, or other Federal,
State, or local agencies as required or permitted by law. In addition, information may be referred to interested parties under the Freedom of Information Act, to financial
consultants, advisors, lending institutions, packagers, agents, and private or commercial credit sources, to collection or servicing contractors, to credit reporting agencies,
to private attorneys under contract with FSA or the Department of Justice, to business firms in the trade area that buy chattel or crops or sell them for commission, to
Members of Congress or Congressional staff members, or to courts or adjudicative bodies. Disclosure of the information requested is voluntary. However, failure to
disclose certain items of information requested, including Social Security Number or Federal Tax Identification Number, may result in a delay in the processing of an
application or its rejection.
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it
displays a valid OMB control number. The valid OMB control number for this information collection is 0560-0155. The time required to complete this information collection
is estimated to average 25 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed,
and completing and reviewing the collection of information. RETURN THIS COMPLETED FORM TO YOUR COUNTY FSA OFFICE.