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OMB No. |
3245-0185 |
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Expiration Date: |
XX/XX/2023 |
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Guaranty Loan Status & Lender Remittance Form |
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[ ] |
Check box if lender information reflects changes |
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F |
[ ] |
Check box if secondary market payment |
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O |
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reported is a late payment or prepayment |
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Lender's Name: |
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Lender's Street Address: |
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L |
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D |
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Lender's City, State, Zip: |
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Lender's Contact Person: |
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Contact Person's Telephone No.: |
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Contact Person's Fax No: |
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Month Ending: |
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Next |
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Amt Disbursed |
Amount |
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Total to FTA |
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Guar. Portion |
Remittance |
SBA |
Lender |
Installment |
Status |
this Period |
Undisbursed |
Interest |
Guar. Portion |
Guar. Portion |
Guar. Portion |
Interest Period |
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# of |
Calendar |
Closing |
Penalty |
GP Number |
Loan Number |
Due Date |
(4 - 9) |
on Total Loan |
on Total Loan |
Rate |
Interest |
Principal |
Pymt or Fee |
From |
To |
Days |
Basis |
Balance |
(if any) |
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Total: |
0.00 |
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Total: |
0.00 |
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Status Codes |
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4 Deferred |
7 |
Transferred |
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Grand Total: |
0.00 |
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5 In Liquidation |
8 |
Purchased by SBA |
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Total to FTA + Penalty |
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6 Paid-in-Full |
9 |
Fully Undisbursed |
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Check/Wire Amt: |
0.00 |
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PLEASE NOTE: The estimated burden for completing this form is 1 hour per response. |
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You are not required to respond to any collection of information unless it displays a currently valid OMB approval number. |
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Comments on the burden should be sent to U.S. Small Business Administration, Chief, AIB, 409 3rd St., S.W., Washington D.C. 20416. |
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And Desk Officer for the Small Business Adminstration, Office of Management and Budget, New Executive Office Building, Room 10202, Washington, D.C. 20503. |
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OMB Approval (3245-0185). PLEASE DO NOT SEND FORMS TO OMB. |
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