5001-11B Guaranteed Loan Report Of Loss - Final Loss or Bkr Reorg

USDA
Form RD 5001-11B
(00-00)

GUARANTEED LOAN REPORT OF LOSS
FINAL LOSS or BKR REORG (w/ no collateral)

1. STATE - COUNTY - GLS BORROWER ID

3. LOAN TYPE

2. AGENCY
LOAN NO.

Community Programs ____
Water and Waste Disposal ____
Business and Industry _____
Rural Energy for America Program ____
6. AGENCY’S LENDER
5. LENDER TAX ID NO.
BRANCH NO.

4. BORROWER NAME
7. LENDER ROUTING NUMBER

8. LENDER ACCOUNT NUMBER

GUARANTEED LOAN ITEMS:

FORM APPROVED
OMB NO.0572-0155

$ DOLLARS

9. ACCOUNT TYPE
___Savings ___Checking

ADJUSTMENTS TO PROTECTIVE ADVANCES &
INTEREST:

10. DATE OF SETTLEMENT
Mo
Da
Yr.
11. CURRENT PRINCIPAL BALANCE

20. PROTECTIVE ADVANCES PLUS INTEREST

$0.00

(Item 13 + Item 14) X Item 16
12. ACCRUED INTEREST OWED

21. REMAINING BALANCE LOSS
GUARANTEE (Item 19 minus Item 20)

13. PRINCIPAL BALANCE OWED ON PROTECTIVE
ADVANCES

22. PERCENT OF GUARANTEED PORTION
HELD BY LENDER

$0.00
(Percent)

14. ACCRUED INTEREST ON
PROTECTIVE ADVANCES
23. LOSS ON GUARANTEED PORTION
HELD BY LENDER OR HOLDER

15. BASIC LOSS (Add Items 11-14)

$0.00

(Item 20 X Item 21)

LOSS GUARANTEED:
$ DOLLARS
__________________________________________________________

24. UNPAID ANNUAL/LATE FEES

(Percent)
16. PERCENT OF LOSS GUARANTEED
__________________________________________________________

25. AMOUNT DUE TO LENDER
(Item 22 minus Item 23)

17. AMOUNT TO BE PAID

$00.00

(Item 15 X item 16)
__________________________________________________________
18. Sum of
(Prin. Advanced Item on Loan 12) X Item 16

$0.00

__________________________________________________________
19. MAXIMUM LOSS ALLOWED

$0.00

(Lesser of Items 17 or 18)
__________________________________________________________

AMOUNT DUE LENDER OR USDA: (If Applicable)
26. PAID ANNUAL/LATE FEES
27. AMOUNT PAID ON ESTIMATED LOSS
28. BALANCE DUE LENDER

(Item 25) minus (Item 27 + Item 26)

29. INTEREST ON OVERPAYMENT
(Accrued interest due USDA)

30. AMOUNT DUE USDA BY LENDER
(Item 27 - Item 25 - Item 26 + Item 29)

31. NAME OF LENDER
32. LENDER SIGNATURE
33. LENDER REP. TITLE

34. DATE
35. NAME OF USDA REPRESENTATIVE
36. USDA SIGNATURE
37. USDA REPRESENTATIVE TITLE
38. DATE
FINANCE OFFICE ONLY
38. CHECK ISSUE CODE

1 = SYSTEM GENERATED
2 = MANUAL CHECK
3 = NO CHECK ISSUED
4 = REFUND
5 = EFT

39. PAYMENT DATE
Mo
Da
Yr.

40. DATE OF DEPOSIT
Mo

Da

Yr.

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 currently
valid OMB control number. The valid OMB control number for this collection is 0572-0155. The time required to complete this information collection is estimated to average 1 hour 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.
Responses to this collection of information are mandatory (7 CFR 5001). Send comments on the agency's need for this information, the accuracy of the provided burden estimates, and any