APPLICATION
FOR GUARANTEE
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INSTRUCTIONS
FOR PREPARATION
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Purpose:
Lenders
use this form to apply for an FSA loan guarantee.
Loan
applicants should not
submit this form to FSA. This form is submitted to FSA by
lenders after the lender has recorded the required information.
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Handbook Reference:
2-FLP
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Number of Copies:
Original
copy.
Lenders
submit the original of the completed form in hard copy, scanned
via email or facsimile to the appropriate USDA servicing office.
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Signatures Required:
Applicant,
Co-Applicant, Co-Signer, Entity Member, and Lender.
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Distribution of
Copies:
Original
to FSA servicing office. (Documents
sent via email or facsimile are considered originals)
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Automation-Related
Transactions: GLS
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Lenders
who have established electronic access credentials with USDA eforms
may electronically transmit this form to the USDA servicing office.
The application will be processed; however, the original, signed
copy (hard, scanned/emailed or facsimile) of the form must be
submitted to the local servicing office before FSA can issue a loan
guarantee. Features for transmitting the form electronically are
available to those customers with access credentials only. If you
would like to establish online access credentials with USDA, follow
the instructions provided at the USDA eForms web site. If lenders
haven’t established electronic access credentials with USDA,
they can also submit the application via email or facsimile.
All
loan applicants must complete Part A and Parts D through F. Entity
applicants must complete Part B. Individual applicants must complete
Part C. Co-applicants, co-signers, and entity members must complete
Parts O and P. Ethnicity, race, gender, and veteran status
information is voluntary. Additional pages for Parts O and P may be
attached for additional co-applicants, entity members or co-signers.
Lenders
must complete Parts G through M.
NOTE:
Any questions answered “NO” may require additional
information.
Lenders
should contact the local FSA Office for more direction.
Fld. Name/
Item
No.
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Instruction
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PART A –
Type of Operation (Loan Applicant)
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1
Type
of Operation
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Check the appropriate
box for the type of operation. Entity applicants complete Part
B. Individual applicants complete Part C.
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PART B –
Entity Applicant Information (Loan Applicant)
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1
Entity
Name
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Enter the entity’s
name.
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2
Entity
Address
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Enter the entity’s
business mailing address. Include the physical address if
different from mailing address.
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3
Number
of Entity Members
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Enter the number of
individuals and/or embedded entities who have an ownership
interest in the entity. All members must complete Parts O and
P. (Refer to 2-FLP, paragraph 111 (d) for embedded entity
information)
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4
Entity
Tax ID Number
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Enter the entity’s
tax ID number.
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5
Entity
Headquarters County
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Enter the county where
the entity’s headquarters is located.
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6
Entity
Telephone Number
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Enter the telephone
number (Including Area Code) for the entity.
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7
Entity
Telephone Type
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Check the telephone type
(Home, Cell, Work) for the entity.
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PART C –
Individual Applicant Information (Loan Applicant)
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1
Applicant’s
Full Legal Name
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Enter the applicant’s
complete legal name.
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2
Applicant’s
Address
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Enter applicant’s
complete mailing address, including physical address if
different from mailing address.
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3
Applicant’s
Birthdate
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Enter applicant’s
date of birth (MM-DD-YYYY).
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4
Applicant’s
9 Digit Social Security or Tax ID Number
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Enter applicant’s
9-digit social security number or tax ID number.
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5
Residence
or Headquarters
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Enter county the
applicant resides and the county where the headquarters office
is located if different from each other.
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6
Applicant’s
Telephone Number
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Enter applicant’s
home or business telephone number, including area code.
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7
Applicant
Telephone Type
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Check the telephone type
(Home, Cell, Work) for the applicant.
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8
Marital
Status
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For individual
applicants, check the box that most closely corresponds to
current marital status.
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9
Citizenship
Status
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Check appropriate box.
If not a U.S. citizen, applicant will be asked to provide I-551
and/ or other proper documentation of immigration status as
found under PRWORA (8 U.S.C. 1641)
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PART D –
Other Information (Loan Applicant)
Note:
To be considered a Socially Disadvantaged Applicant, the
majority interest must be held by eligible individual(s)
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1
Other
Business Names
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If the individual
applicant or entity applicant has conducted business under any
other name, answer “YES”. If not, answer “NO”.
If
“YES”, enter the other name(s) the applicant has
used.
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2A
Ethnicity
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Check the appropriate
box indicating individual applicant or entity applicant
ethnicity.
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2B
Race
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Check the appropriate
box or boxes indicating individual applicant or entity
applicant race.
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2C
Gender
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Check the appropriate
box indicating individual applicant or entity applicant gender.
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2D
Veteran
Status
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Check the appropriate
box indicating individual applicant or entity applicant veteran
status.
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PART E –
Eligibility Information (Loan Applicant)
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1
Description
of Operation
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Describe the applicant’s
operation or proposed operation including the commodity(s) that
is or will be produced.
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2
Operator
of a Family Farm
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Check “YES”
if the applicant is or will be the operator of a family size
farm. If not, check “NO”.
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3
Number
of Years
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Enter number of years
individual applicant or entity applicant has operated a farm.
If applicant is an entity, number of years farming for each
entity member must be input.
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4
Acres
Owned
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Enter total number of
acres individual applicant or entity applicant currently owns.
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5
Acres
Rented
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Enter total number of
acres individual applicant or entity applicant currently rents.
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6
Debt
Forgiveness
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Check “YES”
if you (including all members if an entity) have NOT
caused the Agency any loss. If you have, check “NO”.
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7
Delinquent
Debt to the U.S. Government
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Check “YES”
if you (including all members if an entity) do NOT have
any delinquent debt owed to the US Government. If you have
delinquent debt owed to the US Government, check “NO”.
Debt
to the U.S. Government includes but is not limited to education
loans, obligations to the Commodity Credit Corporation, Natural
Resources Conservation Service, Veterans Administration, FSA,
Rural Housing Service or Federal Crop Insurance
Corporation/Risk Management Agency.
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8
Outstanding
Recorded Judgments
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Check “YES”
if you (including all members if an entity) do NOT have
any outstanding judgements obtained by the U.S. in Federal
Court. If you do have recorded judgements, check “NO”.
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9
Citizen
of the US
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Check “YES”
if you or the members holding majority interest in the entity
are citizens of the U.S., a U.S. non-citizen national, or a
qualified alien under applicable Federal immigration laws. If
not, check “NO”.
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10
Legal
Capacity
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Check “YES”
if you (including all members if an entity) have the
legal capacity to incur debt. If not, check “NO”.
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11
Controlled
Substances
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Check “YES”
if you (including all members if an entity) have NOT
been convicted of planting, cultivating, growing, producing,
harvesting, storing, trafficking, or possessing a controlled
substance within the last 5 crop years. If you have been
convicted, check “NO”.
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12
Disqualification
due to Crop Insurance violation
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Check “YES”
if you (including all members of an entity) are NOT ineligible
due to disqualification resulting from a Federal Crop Insurance
violation according to 7 CFR Part 718. If you are ineligible
for this reason, check “NO”.
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13
Employee
or Related to an Employee
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Check “YES”
if you (including all members if an entity) are NOT an
employee, related to an employee, or an associate of an
employee of the lender or Farm Service Agency. If you are,
check “NO”.
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14
Sufficient
Credit
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Check “YES”
if you (including all members if an entity) are UNABLE
to get credit without a guarantee. If you are able to, check
“NO”.
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15
False
Statements
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Check “YES”
if you (including all members if an entity) have NOT
given FSA false or misleading documents or statements in the
past. If you have, check “NO”.
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PART
F - Loan Applicant Certifications (Loan Applicant)
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Certification/
Acknowledgment
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Please read the
statements in this section carefully before signing.
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1A
Signature
of Applicant
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Enter the signature of
the applicant.
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1B
Capacity
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Check “Self”
if you are signing for yourself. Check “Entity
Representative” if you are signing on behalf of an
entity. Check both boxes if applicable.
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1C
Date
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Enter the date
(MM-DD-YYYY) the applicant signed the form.
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PART
G - Type of Assistance Requested (All Lender Types)
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1
Request
Number
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Enter number of requests
for each guarantee request submitted on FSA-2211. For example:
If form FSA-2211 is submitted for Guaranteed FO assistance
only, this item should be completed to show “1 of 1”
and Parts G, H, and I would be completed only once.
If
form FSA-2211 is submitted for Guaranteed FO assistance,
Guaranteed OL assistance, and Guaranteed OL-Line of Credit
assistance, only Parts G, H, and I must be completed for each
guarantee requested. The separate request section should be
completed to show “1 of 3", “2 of 3", and
“3 of 3”.
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2
Loan
Type
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Check the appropriate
box for the type of loan the applicant is requesting.
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3
EZ
Guarantee
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Check “YES”
if the guarantee request is submitted under the EZ Guarantee
program. Check “NO” if the guarantee request is
NOT submitted as an EZ Guarantee.
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4
Loan
Amount or LOC Ceiling
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Enter the amount of the
loan request or Line-of-Credit (LOC) ceiling.
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5
Interest
Rate
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Enter the rate of
interest the loan applicant will be charged and check the
appropriate box if the rate is “Fixed” or
“Variable”.
Note:
If the interest rate is variable or fixed for less than five
years, check Variable.
If
the interest rate is fixed for five or more years, check Fixed.
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6
Requested
Guarantee Percentage
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Check “Maximum”
box if requesting that FSA consider the maximum guarantee
percentage allowable or choose “Other” and enter
the requested guarantee percentage if a guarantee percentage
less than the maximum is desired.
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7
Repayment
Period
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Enter the repayment
period (years) for the loan requested.
Note:
For LOC, enter the number of years the loan will be
outstanding, not the
number
of years of advances.
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8
Principal
Repayment Terms
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Enter the principal
repayment terms for the loan requested, including estimated
installment; even, uneven, balloon; and frequency of
installment.
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9
Interest
Repayment Terms
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Enter the interest
repayment terms for the loan requested, including estimated
installment; even, uneven, balloon; and frequency of
installment.
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PART
H – Funds Purpose (All Lender Types)
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1
Funds Purpose
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Enter purpose for which
loan funds obtained under FSA guarantee will be used.
Example
1: OL/LOC Request for Guarantee
Annual
operating costs for cash grain operations
Annual
family living costs
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Example 2: OL
to refinance ‘authorized’ farming debts
Carry-over operating
losses
Machinery and Equipment
debts
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2
Funds
Amount
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Enter the amount of
money to be used for each purpose.
Example
1: OL/LOC Request for Guarantee
Annual
operating costs for cash grain operations $30,000
Annual
family living costs
$18,000
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Example 2: OL
Request for Guarantee
Carry-over
operating losses $92,000
Machinery
and Equipment debts $88,000
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PART
I - Proposed Security (All Lender Types)
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1
- 5
Proposed
Security
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Enter specific security
information for each field.
Example
1:
OL/LOC
Request for Guarantee
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1.
Item
Description
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2.
Lien
Position
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3.
Est.
Value
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4.
Amount
of Prior Lien
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5.
Collateral
Value
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Crops
Machinery
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1st
2nd
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$96,000
$82,000
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$0
$50,000
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$96,000
$32,000
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Example 2:
OL
Request for Guarantee
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1.
Item
Description
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2.
Lien
Position
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3.
Est.
Value
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4.
Amount
of Prior Lien
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5.
Collateral
Value
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Machinery/Equipment
RE
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1st
2nd
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$280,000
$82,000
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$65,000
$50,000
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$215,000
$32,000
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6
Totals
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Enter totals of column
from Items 3, 4 and 5.
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PART J –
Interest Assistance Documentation (Applicable Only for Interest
Assistance Applications)
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1
Net
Cash Flow without Interest Assistance
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Enter information from
the applicant’s cash flow budget. This item should be
completed for all requests for assistance
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2
Net
Cash Flow with Interest Assistance
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Complete Item 2 only
if Item 1 is negative and the lender is requesting interest
assistance. If applicant has multiple guaranteed loans, lender
is to indicate on which loans interest assistance is requested.
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PART K – EZ
Guarantee Documentation (Applicable Only for EZ Guarantee
Applications)
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1
Applicant
shows the ability to repay…
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Check “YES”,
if your analysis shows the applicant shows the ability to repay
this loan. If not, check “NO”.
Repayment
can be demonstrated by such things as:
Scorecard
analysis score of _______
Historical
debt coverage ratio of _____
Pro
forma debt coverage ratio of ______
Or
other repayment capacity indicator calculated
Also
include how this compares to your minimum underwriting standard
or acceptable level of risk.
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2
Applicant
has Acceptable Credit History
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Check “YES”
if applicant, including all members of the entity, have
acceptable credit history. If not, check “NO”.
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PART
L - Environmental Information (All Lender Types)
Lenders
shall carefully consider questions 1 through 8 and respond with
the appropriate answers for the farm operation proposed for
guarantee. If the lender has questions regarding these issues,
the FSA Farm Loan Manager at the local USDA Service Center
should be contacted for assistance.
Lenders
must complete a site visit to the operation and conduct
environmental reviews as applicable.
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1
HEL/WL
Compliance
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Check “YES”
if compliance on the AD-1026 has been certified and is on file.
Otherwise check “NO”.
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2
Land
Use
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Check “YES”
if proceeds from this request or project will NOT accommodate
any shift in land use, ground disturbance, clearing of woody
vegetation or stumps, or for drilling of a well. Otherwise
check “NO”.
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3
Floodplains
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Check “YES”
if the property on which farming activities are taking place is
NOT located near or within a floodplain. Otherwise check “NO”.
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4
Historical
and Archaeological Sites
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Check “YES”
if property on which farming activities take place is NOT known
to be of historical significance or contain any known
archaeological sites. Otherwise check “NO”.
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5
Hazardous
Substances
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Check “YES”
if property on which the farming activities take place is NOT
known to be contaminated with hazardous substances or waste and
does NOT contain underground storage tanks. Otherwise check
“NO”.
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6
Endangered
Species
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Check “YES”
if there are NO known endangered species or habitats that will
be disturbed by the operation. Otherwise check “NO”.
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7
Environmental
Compliance
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Check “YES”
if there are NO pending or active lawsuits regarding
environmental compliance against the operator or property and
there are NO environmental liens or judgements filed against
the property as a result of not complying with Federal or State
environmental laws. Otherwise check “NO”.
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8
State
Water Quality Standards
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Check “YES”
if this is NOT a livestock operation. Check “NO” if
this is a livestock operation and include number of animals and
type of livestock.
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PART
M - Lender Information and Certification (All Lender Types) -
Read the certification statement.
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1
Lender
Status
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Check box that
represents current lender status.
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2A - G
Lender
Certifies
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Item G - All lenders
enter the effective date of FSA-2201, Lender’s Agreement.
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3A - B
Lending
Institution Name, Address & Telephone Number
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Enter the Lender’s
name, complete mailing address and phone number (Include
Area Code).
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4A
Lender
Tax ID Number
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Enter the Lender’s
9 Digit Tax ID Number.
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4B
Regulatory
Agency
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Enter the lender’s
primary oversight agency (e.g., FDIC, OCC, FCA).
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5
Email
Address
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Enter lender
representative’s email address.
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6A
Name
of Lender's Representative
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Enter the name of
official authorized to execute official binding documents on
the lender’s behalf.
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6B
Title
of Lender Representative
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Enter the title of
official authorized to execute official binding documents on
the lender’s behalf.
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7A
Signature
of Authorized Lender Representative
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Enter the signature of
the individual whose name appears in Item 4A. The lender should
promptly submit the completed application to FSA for
consideration.
If
you are mailing, emailing or faxing this form, print the form
and manually enter your signature. If this form is approved for
electronic transmission and you have established credentials
with USDA to submit forms electronically, use the buttons
provided on the form for transmitting the form to the USDA
servicing office
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7B
Date
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Enter the date the
official authorized to execute official binding documents on
the lender's behalf signed this form.
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PART
N - FSA USE ONLY
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1A
Date
Received
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Insert date application
is received.
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1B
Date
Completed
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Insert date application
is determined complete.
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PART O –
Co-Applicant / Entity Member / Co-Signer Information (If
Applicable)
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1A
Co-Applicant’s,
Entity Member’s, or Co-Signer’s Name
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Enter the
co-applicant’s, entity member’s, or co-signer’s
complete legal name.
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1B
Co-Applicant’s,
Entity Member’s, or Co-Signer’s ID Number
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Enter co-applicant’s,
entity member’s, or co-signer’s social security
number or tax ID Number.
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1C
Co-Applicant’s,
Entity Member’s, or Co-Signer’s Birthdate
|
Enter co-applicant’s,
entity member’s, or co-signer’s date of birth
(MM-DD-YYYY).
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1D
Co-Applicant’s,
Entity Member’s, or Co-Signer’s Address
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Enter the
co-applicant’s, entity member’s, or co-signer’s
complete mailing address, including physical address if
different from mailing address.
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1E
Residence
or Headquarters
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Enter county the
co-applicant, entity member, or co-signor resides in or the
county where the headquarters office is located if an embedded
entity.
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1F
Co-Applicant’s,
Entity Member’s, or Co-Signer’s Telephone No.
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Enter co-applicant’s,
entity member’s, or co-signer’s home or business
telephone number, including area code.
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1G
Co-Applicant’s,
Entity Member’s, or Co-Signer’s Telephone Type
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Check the
co-applicant’s, entity member’s, or co-signer’s
telephone type (Home, Cell, Work)
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1H
%
Ownership
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Enter the percent of the
entity that is owned by the member.
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1I
Co-Signer
Only
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Check this box if acting
as co-signer only.
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1J
Marital
Status
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Check the box that most
closely corresponds to current marital status of the
co-applicant or the entity member, if an individual.
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1K
Citizenship
Status
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Check appropriate box.
If not a U.S. citizen, applicant will be asked to provide I-551
and/ or other proper documentation of immigration status as
found under PRWORA (8 U.S.C. 1641)
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Items 1L –
1O – Voluntary Information for Monitoring Purposes
(Complete as applicable)
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1L
Ethnicity
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Check the appropriate
box indicating your ethnicity.
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1M
Race
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Check the appropriate
box or boxes indicating your race.
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1N
Gender
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Check the appropriate
box indicating your gender.
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1O
Veteran
Status
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Check the appropriate
box indicating your veteran status.
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Note: If
additional Co-Applicants, Entity Members, or Co-Signers;
complete Items 2A – 2O. Additional copies of Pages 5
and 6 may be attached if necessary.
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PART P –
Co-Applicant, Entity Member, and/or Co-Signer Certifications
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Certification/
Acknowledgment
|
Please read the
statements in this section carefully before signing.
|
1A
Signature
of Co-Applicant or Entity Member
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Enter the signature of
the co-applicant or entity member.
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1B
Capacity
|
Check “Self”
if you are signing for yourself. Check “Entity
Representative” if you are signing on behalf of an
entity. Check both boxes if applicable.
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1C
Date
|
Enter the date
(MM-DD-YYYY) the co-applicant or entity member signed
the form.
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Note: If
additional Co-Applicants, Entity Members, or Co-Signers
complete Items 2A – 2C in the same manner.
Additional copies of
Pages 5 and 6 may be attached if necessary.
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PART Q –
Supporting Information for SEL/CLP lenders (For SEL/CLP Lenders
Completing Non-EZ Guaranteed Loans)
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1
Please
attach the following
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Attach the appropriate
items as indicated for SEL or CLP lenders.
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