FSA2501Ins _final version

FSA-2501 Date of Modification (proposal 1)

ADDENDUM TO THE PROMISSORY NOTE OR ASSUMPTION AGREEMENT

FOR SET-ASIDE PROGRAMS

INSTRUCTIONS FOR PREPARATION

Purpose: This form is used to amend the existing promissory note or assumption agreement and set forth the terms and conditions for borrower(s) participating in the Disaster Set-Aside (DSA) Program or Distressed Borrower Set-Aside (DBSA). The agency completes the form. It is then signed by the borrower(s) and attached to the promissory note or assumption agreement. A separate set-aside addendum is prepared for each promissory note or assumption agreement. Four signature lines are provided. If additional signature lines are required, a duplicate addendum may need to be prepared.
Handbook Reference: 5-FLP	Number of Copies: Original and Two
Signatures Required: Original is signed by the borrowers with both copies conformed (/s/). All parties (entity & individual) that signed the promissory note or assumption agreement are required to sign an addendum.
Distribution of Copies: Original to fireproof safe, attached to the reference promissory note. One copy to the official agency file, attached to the copy of the reference promissory note. The second copy is delivered to the borrower.
Automation-Related Transactions: (Instructions for writers: provide only the information required, i.e. ADPS TC 3K. If no automation actions are required, insert N/A) ADPS – 5S

Item	Instruction
1 Name	Enter the name as it appears on the promissory note associated with the set-aside.
2 Full Case Number	Enter the 2 digit number assigned to your state farm loan program accounts (non-FIPS); the 3 digit number (beginning with 0) assigned to your county farm loan program accounts (Non-FIPS); and the 9 digit social security or tax identification number assigned to the account. The full case number is required as this document is used as a source document for ADPS transaction 5S.
3A Fund Code	Enter the Fund Code of the promissory note or assumption agreement associated with the set-aside.
3B Loan Number	Enter the Loan Number of the promissory note or assumption agreement associated with the set-aside.
3C Date	Enter the date as it appears on the promissory note or assumption agreement associated with the set-aside.
3D Amount	Enter the amount of the promissory note or assumption agreement associated with the set-aside. This is the original, face value of the note and not an undisbursed amount or unpaid balance.
4A Disaster Designation Number (Disaster Set-Aside Only)	Enter the disaster designation number as assigned to the disaster declaration.
4B Date of Scheduled Installment	Enter the date the installment being set aside was/is due.
4C Amount of Installment Set-aside	Enter the Amount of the installment being set-aside. This amount cannot exceed the amount due as shown on the promissory note or assumption agreement associated with the set-aside. It may, however, be less than the installment amount if the borrower is able to pay a part of the installment due, or has already paid a part of the installment.
5 Type of set-aside	Check the appropriate box
6A-9A Borrower’s Name	Enter the name of the borrower or individually liable party that will sign/execute this addendum. Four signature lines are provided. If additional signature lines are required, a duplicate addendum may need to be prepared.
6B – 9B Signature	The borrower or individually liable party will sign/execute this addendum.
5C – 9C Date	Enter the date the borrower or individually liable party will sign/execute this addendum.

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