5001-11C Guaranteed Loan Report Of Loss - Bankruptcy Reorg w/Coll

USDA
Form RD5001-11C
(00-00)

FORM APPROVED OMB
NO.0572-0155

GUARANTEED LOAN REPORT OF LOSS
BANKRUPTCY REORG w/ Collateral
2. AGENCY
LOAN NO.

1. STATE - COUNTY - GLS BORROWER ID

3. LOAN TYPE

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

4. BORROWER NAME

5. LENDER TAX ID NO

7. LENDER ROUTING NUMBER

8. LENDER ACCOUNT NUMBER

GUARANTEED LOAN ITEMS:

$ DOLLARS

10. DATE OF SETTLEMENT
Mo
Da
Yr.

LOSS GUARANTEED:

9. ACCOUNT TYPE
___Savings ___Checking

$ DOLLARS

29. PERCENT OF LOSS
GUARANTEED

11. CURRENT PRINCIPAL BALANCE

(Percent)

30. AMOUNT TO BE PAID
(Item 28 X item 29)
31. Product of (Prin. Advanced on Loan +
Item 12) X Item 29
32. MAXIMUM LOSS ALLOWED

12. ACCRUED INTEREST OWED
13. TOTAL (Item 11 + Item 12)

$0.00
$0.00

(Lesser of Items 30 or 31)

PRIOR LIEN AMOUNTS OWED AT SETTLEMENT DATE:

ADJUSTMENTS TO PROTECTIVE ADVANCES &
INTEREST:
33. PERCENT OF GUARANTEED PORTION
HELD BY LENDER
34. LOSS ON GUARANTEED PORTION
HELD BY LENDER (Item 32 X Item 33)

14. REAL ESTATE DEBTS
15. PERSONAL PROPERTY DEBTS
16. UNPAID TAXES, ASSESSMENTS, GROUND
RENTS, ETC.

35. UNPAID ANNUAL/LATE FEES

17. TOTAL PRIOR LIENS

36. AMOUNT DUE TO LENDER

(Add Items 14 - 16)

(Percent)

(Item 34 minus Item 35)

COLLATERAL:
18. REAL PROPERTY VALUE

AMOUNT DUE LENDER OR USDA: (If Applicable)

19. CHATTEL PROPERTY VALUE
20. VALUE OF PERSONAL AND
CORPORATE GUARANTEES
21. TOTAL (Add Items 18 – 20
37. NAME OF LENDER

22. NET COLLATERAL
(Item 21 minus Item 17)

$0.00

23. BASIC LOSS (Item 13 minus Item 22)

ADJUSTMENT TO BASIC LOSS:

38. LENDER SIGNATURE
39. LENDER REP. TITLE

24. FUNDS BEING HELD

40. DATE
$0.00

25. INCOME TO BE APPLIED TO DEBT

44

41. NAME OF USDA REPRESENTATIVE

26. BORROWER’S DEBT PAYMENT ABILITY PRESENT VALUE

42. USDA SIGNATURE

27. TOTAL DEDUCTIONS

43. USDA REPRESENTATIVE TITLE

(Add Items 24 - 26)

44. DATE

28. ADJUSTED BASIC LOSS

$0.00

(Item 23 minus Item 27)

FINANCE OFFICE ONLY
45. CHECK ISSUE CODE

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

46. PAYMENT DATE
Mo
Da
Yr.

47. DATE OF DEPOSIT
Mo

Da

Yr.

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