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SBA 504 Loan ApplicationCONTENTS:Additional Documentation....... 3Small Business/Operating Company Information...4Current and Previous SBA and Other Government Debt.6Real Estate Holding Company Information....7Project Information.........8Project Cost Estimates........9Source of Down-payment......10Current and Previous SBA and Other Government Debt..6Personal Information........11Statement of Personal History......12Personal Financial Statement.......14Personal Resume Form.......17Thank you for choosing Small Business Finance Corp for consideration of your real estate or equipment financing needs. In addition to completing the attached loan application materials, please submit the following documentation:Corporate Tax Returns for the previous 3 years for each Operating Company, Real Estate Holding Company (if applicable), and ANY Affiliate Business owned. Please provide ALL schedules, including any K-1s. Each return must be signed at “Sign Here” on the lower left of the front page of the 1120, 1120S or 1065.Year-End Balance Sheet and P&L for the previous 3 years for each Operating Company, Real Estate Holding Company (if applicable), and ANY Affiliate Business owned. Sign and date the first page of each statement.Current Interim Balance Sheet and P&L (within the last 60 days) for each Operating Company and ANY Affiliate Business owned. (Balance Sheet and P&L must have the same date.) Please include an Accounts Payable and an Accounts Receivable Aging report corresponding to the current interim balance sheet. Sign and date the first page of each statement.Business Debt Schedule corresponding to interim balance sheet (form enclosed.)Personal Tax Returns for the previous 3 years for each sole proprietor, partner, stockholder owning 20% or more and each guarantor. Please provide ALL schedules, including any K-1s. Each return must be signed at “Sign Here” on the lower left of the second page on the 1040.Personal Financial Statement (SBA form 413) for each sole proprietor, partner, stockholder owning 20% or more and each guarantor. If joint tax returns are filed, spouse must also sign personal financial statement even if no ownership or guarantee is anizational Documents relating to ALL business entities: for Corporations – By-Laws; Limited Liability Companies – Operating Agreement; Partnerships – Partnership Agreement.Real Estate Purchase – Copy of signed purchase contract.Construction/Remodeling – Copy of construction bids.Equipment Purchase – Copy of bids.Small Business Information (Operating Company):Business Name: _____________________________________________________________________Trade Name (if applicable): ____________________________________________________________Description of business: ______________________________________________________________Street Address: _____________________________________________________________________Mailing Address: (if different than Street Address): __________________________________________________Web Address: _______________________________________________________________________________Phone: _____________________________________________ Fax: __________________________________ Date Business was established: ______________________Business Type: ___ Corporation ___ LLC ___ Partnership ___ Sole Proprietor ___ Other Ownership:Principal #1: full legal name__________________________________________________________________Principal #1: title__________________________________________________________________Principal #1: ownership interest %__________________________________________________________Principal #2: full legal name__________________________________________________________________Principal #2: title__________________________________________________________________Principal #2: ownership interest %__________________________________________________________Principal #3: full legal name__________________________________________________________________Principal #3: title__________________________________________________________________Principal #3: ownership interest %__________________________________________________________Principal #4: full legal name__________________________________________________________________Principal #4: title__________________________________________________________________Principal #4: ownership interest %__________________________________________________________Key Employee #1: full legal name__________________________________________________________Key Employee #2: full legal name__________________________________________________________Who is the Primary Contact?__________________________________________________________________Please list any additional Owners or Key Employees on a separate page and attach to this document.Operating Company Information (Continued)Current number of full-time equivalent employees: _________ Number of full-time equivalent employees planned to be hired in the next two years: ___________Is this business more than 51% woman, minority, or veteran owned? ___YES ___NOIs this business a franchise operation? ___YES ___NODoes this business have a dealership agreement? ___YES ___NODoes this business or any Associate of the business have previous SBA or government related financing? ___YES ___NO Does anyone who owns, manages, or directs this business or their spouse or members of their household work for the Small Business Administration, Small Business Advisory Council, SCORE, ACE, any Federal Agency, or the participating lender? ___YES ___NODoes this business presently engage in export trade, or plan to in the future? ___YES ___NOAn Associate** of the small business or member of any Associate’s household is a GS-13 or higher government employee or a Major or Lieutenant Commander or higher in the military. ___YES ___NOAn SBA employee, the employee’s close relative or a member of the employee’s household is an employee, officer, directory, attorney, agent, creditor or debtor, or has a financial interest in the Small Business. ___YES ___NOA former SBA employee separated from SBA for less than one year is an employee, officer, directory, attorney, agent, creditor or debtor, or has a financial interest in the Small Business. ___YES ___NOIndividual currently involved in a Small Business Development Center program, the individual’s close relative or a member of the individual’s household is an employee, officer, directory, attorney, agent, creditor or debtor, or has a financial interest in the Small Business. ___YES ___NOA Member of Congress or an appointed official or employee of the legislative or judicial branch (or household member of such an individual) is a sole proprietor, general partner, officer, director, employee, attorney, agent, creditor or debtor, or has a financial interest in the Small Business. ___YES ___NOMember or employee of a Small Business Advisory Council or a SCORE volunteer (or a close relative or household member of such an individual) is a sole proprietor, general partner, officer, director, employee, attorney, agent, creditor or debtor, or has 10% or more financial interest in the Small Business. ___YES ___NO** An Associate of a small business is an officer, director, owner of more than 20 percent of the equity, or key employee.Current and Previous SBA and Other Government Debt:Complete the chart below if you, your business, any principal of your business, any affiliate of your business, any other business currently owned by a principal, or any business previously owned by you or a principal of your business has received or applied for any direct or guaranteed financial assistance from the Federal Government, including student loans and disaster loans.All current, previous, and pending Government debt must be listed, including loans that have been paid in full or those that resulted in a loss to the Government. (Note: Loans that resulted in a loss to the Government include loans that were charged off, compromised, or discharged as a result of bankruptcy. The amount of the loss is the outstanding principal balance of the loan that the Government had to write off after all collection activities (including compromise) were finalized.Name of AgencyAgency Loan #Borrower’s NameOriginal Amount of LoanDate of ApplicationLoan StatusCurrent Balance$ Amount of Loss to the Government$$$$$$$$$$$$$$$$$$Business Debt Schedule:Please list all current notes, lines of credit, and mortgages payable. (Present balance should agree with the latest balance sheet submitted.)Payable toOriginal AmountCurrent BalanceInterest RateOriginal DateMaturity DateMonthly PaymentCollateral Securing Debt$$$$$$$$$$$$$$$Real Estate Holding Company Information (if applicable):If an individual or organization other than the active business/operating company will take title to the project real estate, please complete the following section. If the entity taking title is the same as the Operating Company, go to Project Information.Individual Name: ____________________________________________________________________Business Name: _____________________________________________________________________Street Address: _____________________________________________________________________Mailing Address: (if different than Street Address): __________________________________________________Phone: _______________________________________ Fax: ________________________________________Date Business was established: __________________________________________________________Business Type: ___ Corporation ___ LLC ___ Partnership ___ Sole Proprietor ___ Other Real Estate Holding Company Ownership: Please list any additional Owners on a separate page and attach to this document.Principal #1: full legal name__________________________________________________________________Principal #1: title__________________________________________________________________Principal #1: ownership interest %__________________________________________________________Principal #2: full legal name__________________________________________________________________Principal #2: title__________________________________________________________________Principal #2: ownership interest %__________________________________________________________Principal #3: full legal name__________________________________________________________________Principal #3: title__________________________________________________________________Principal #3: ownership interest %__________________________________________________________Note: If there will be a Real Estate Holding Company, there must be a lease between the Real Estate Holding Company and the Operating Company. The lease must be in writing and have a term, including options to renew exercisable solely by the Operating Company, at least equal to the term of the SBA loan (20 years). The lease will be subordinated to SBA’s lien on the property and the rents will be assigned as collateral for the loan The rent or lease payments cannot exceed the amount necessary to make the loan payment to the SBA and the Third Party Lender, and an additional amount to cover the Real Estate Holding Company’s expenses of holding the property, such as maintenance, insurance and property taxes. The Operating Company must lease 100% of the property from the Real Estate Holding Company, but it can sublease a portion of the property. For an existing building, a small business must occupy 51% of the rentable property and may lease up to 49% indefinitely. For new construction, a small business must occupy 60% of the rentable property, may permanently lease up to 20% and temporarily lease an additional 20% with the intention of using some of the additional 20% within three years and all of it within 10 years. Project Information:Address of property to be purchased: ____________________________________________________________Is the project property an existing building or new construction? _______________________________________Square footage of the parcel of land the building occupies:____________________________________ sfSquare footage of project building: ___________________________________________________________ sfSquare footage that your company will occupy: _________________________________________________ sfIf an existing building, in what year was the facility originally constructed? _______________________________Is any other financing being sought in addition to a building purchase? (such as business acquisition, working capital, inventory, etc.): ________________________________________________________________________Tenants:If there are any tenants that will remain in the building, please complete the section to follow. Also, please have your realtor provide copies of all existing leases.Tenant #1 Name: _________________________Tenant #2 Name: _________________________Square footage of tenant: ___________________Square footage of tenant: ___________________Lease expiration date: _____________________Lease expiration date: _____________________Tenant #1 Name: _________________________Tenant #2 Name: _________________________Square footage of tenant: ___________________Square footage of tenant: ___________________Lease expiration date: _____________________Lease expiration date: _____________________Please list any additional Tenants on a separate page and attach to this document.Project Cost Estimates:Please fill in the estimate of those categories that will be financed as part of this loan.HARD COSTS:*Purchase Land$*Purchase Land and Existing Building$*Purchase Improvements$*Construct a Building $*Add an Addition to a Building$*Make Renovations to a Building$*Make Leasehold Building Improvements$*Purchase Equipment$*Install Equipment$*Purchase Furniture and/or Fixtures$Other$ Sub Total$SOFT COSTS:Construction Contingency (maximum 10% of estimated construction cost)$Interim Interest $*Architect$*Engineering$Appraisal$Environmental Study$Other$ Sub Total$ TOTAL PROJECT COSTS$Prior to submission of the application package to the Small Business Administration, actual bids on each of these cost components will be needed.Source of Down-payment:The minimum down-payment required depends upon the type of real estate being purchased, the maturity of the small business, and other credit factors. Typical down-payments are 10%, 15% or 20% of the total project cost. We need to understand the sources from which the down payment will be provided. If more than one source will be used, please indicate how much from each source.____Personal Cash: From whom: ________________________________________ Amount $__________________Business Cash:From:__________________________________________a___ Amount $__________________Equity in the Project Real Estate:Original cost of property: $____________________________________________Current loan balance (if applicable):$____________________________________________Current market value (estimated):$____________________________________________ Date Purchased (mm/dd/yy)$____________________________________________ Current market value (estimate)$____________________________________________ ____BorrowedFrom:________________________________________ Amount $____________________ Personal Information:Three documents follow. The SBA’s Statement of Personal History (SBA form 912), the SBA’s Personal Financial Statement (SBA form 413), and a resume form. The specific individuals who need to complete these forms vary and are specified below:Statement of Personal History (SBA form 912):Every proprietor, general partner, officer, director, managing member of a limited liability company (LLC), owner of 20% or more of the Applicant, Trustor (if the Small Business Applicant is owned by a trust), and any person hired by the Applicant to manage day-to-day operations (Key Employee) must complete this form. Every person completing a 912 must answer each question fully giving details about any “yes” response. NOTE: A “yes” is required even when the record is allegedly sealed, expunged or otherwise unavailable. (This information is kept private and confidential.) There are no exceptions to or waivers of this policy. (a) If every Subject Individual answers questions 7, 8 and 9 as “no,” normal loan processing may proceed. (b) If a Subject Individual answers “yes” to question 7, then the Small Business Applicant is not eligible. (c) If a Subject Individual answers “yes” to question 8 or 9, then that individual must go through a background check and character determination unless the charge resulting in a “yes” answer was a single misdemeanor that was subsequently dropped without prosecution. (Documentation from the appropriate court or prosecutor’s office must be attached to the SBA Form 912 and maintained in the CDC’s loan file.) If the individual pled guilty to the charges or to lesser charges the background check and character determination must be conducted. Currently, SBA conducts two types of background checks: (1) a Name Check, which requires a search of available records based on a person’s name and social security number (SSN); and (2) a Fingerprint Check, which searches available records based on the person’s name and SSN plus a complete and legibly written FD-258 Fingerprint Card. Personal Financial Statement (SBA form 413):This form must be completed by: (I) each proprietor; (2) general partner; (3) managing member of a limited liability company (LLC); (4) each owner of 20% or more of the equity of the Applicant (including the assets of the owner's spouse and any minor children); and (5) any person providing a guaranty on the loan.Personal Resume:This form must be completed by: (I) each proprietor; (2) general partner; (3) managing member of a limited liability company (LLC); (4) each owner of 20% or more of the equity of the Applicant. A prepared resume may be substituted for this form.39516051793875owned or to be owned in the small business00owned or to be owned in the small business0000160655196215001320808191500141605433958900141605107251400141605323468900141605539686400372300416821150000001522730272415United States of America00United States of America00001113155472440SMALL BUSINESS ADMINISTRATION00SMALL BUSINESS ADMINISTRATION00001046480653415STATEMENT OF PERSONAL HISTORY00STATEMENT OF PERSONAL HISTORY00003780155110490Please Read Carefully:00Please Read Carefully:00005285105148590SBA uses Form 912 as one part of its00SBA uses Form 912 as one part of its00001987551091565Name and Address of Applicant (Firm Name) (Street, City, State, and ZIP Code)00Name and Address of Applicant (Firm Name) (Street, City, State, and ZIP Code)1416051672589003732530137731400000037706301082040SBA District/Disaster Area Office00SBA District/Disaster Area Office000037801551396365Amount Applied for (when applicable)00Amount Applied for (when applicable)5523229137731500000056280051386840File No. (if known)00File No. (if known)000021780516916401.? ? Personal Statement of:? (State name in full, if no middle name, state (NMN),001.? ? Personal Statement of:? (State name in full, if no middle name, state (NMN),00004083051777365or if initial only, indicate initial.)? List all former names used, and dates each 00or if initial only, indicate initial.)? List all former names used, and dates each 00004083051863090name was used.? Use separate sheet if necessary.00name was used.? Use separate sheet if necessary.00003130551996440First / Middle / Last00First / Middle / Last00001606552672715Name and Address of participating lender or surety co. (when applicable and know) 00Name and Address of participating lender or surety co. (when applicable and know) 37325302025014000000379920520535903.? ? Date of Birth:? (Month, day, and year)003.? ? Date of Birth:? (Month, day, and year)0000379920523583904.? ? Place of Birth:? (City & State or Foreign Country)004.? ? Place of Birth:? (City & State or Foreign Country)0000380873027108155.? U.S. Citizen?005.? U.S. Citizen?45326302710815004989830271081500000046564552720340YES00YES000051231802720340NO00NO000038087303120390If non-U.S. citizen provide alien registration number:00If non-U.S. citizen provide alien registration number:000020828032632656.? ? Present residence address:006.? ? Present residence address:00003606803387090From:00From:00003702053529965To:00To:00003702053644265Address:00Address:00003797303987165Home Telephone No.? (Include Area Code):00Home Telephone No.? (Include Area Code):00002654304149090Business Telephone No.? (Include Area Code):00Business Telephone No.? (Include Area Code):000035325053396615From:00From:000035229803568065To:00To:141605265366400000035325053272790Most recent prior address (omit if over 10 years ago):00Most recent prior address (omit if over 10 years ago):00002463804415790PLEASE SEE REVERSE SIDE FOR EXPLANATION REGARDING DISCLOSURE OF INFORMATION AND THE USES OF SUCH INFORMATION. 00PLEASE SEE REVERSE SIDE FOR EXPLANATION REGARDING DISCLOSURE OF INFORMATION AND THE USES OF SUCH INFORMATION. 141605573976400000022733054349657.? ? Are you presently subject to an indictment, criminal information, arraignment, or other means by which formal criminal charges are brought in any jurisdiction?007.? ? Are you presently subject to an indictment, criminal information, arraignment, or other means by which formal criminal charges are brought in any jurisdiction?55118055968900000006940555596890Yes00Yes1017905559689000000011607805596890No00No000023685557683408.? ? Have you been arrested in the past six months for any criminal offense?008.? ? Have you been arrested in the past six months for any criminal offense?5511805939790001027430593979000000025590561398159.? ? For any criminal offense – other than a minor vehicle violation – have you ever: 1) been convicted; 2) plead guilty; 3) plead nolo contendere; 4) been placed 009.? ? For any criminal offense – other than a minor vehicle violation – have you ever: 1) been convicted; 2) plead guilty; 3) plead nolo contendere; 4) been placed 00004559306235065on pretrial diversion; or 5) been placed on any form of parole or probation (including probation before judgment).00on pretrial diversion; or 5) been placed on any form of parole or probation (including probation before judgment).55118063969900010369556396990007988306244589001416056092189001416056539864001320806768464001320807263764001416057520939004368807654290004368807854315000000265430655891510?? I authorize the Small Business Administration Office of Inspector General to request criminal record information about me from criminal justice agencies?? 0010?? I authorize the Small Business Administration Office of Inspector General to request criminal record information about me from criminal justice agencies?? 00005797557654290Fingerprints Waived00Fingerprints Waived00005797557844790Fingerprints Required00Fingerprints Required00005892807959090Date Sent to OGI00Date Sent to OGI1303655804481400000020847057701915Date00Date000020847057997190Date00Date20751807701914002075180798766400000024657057701915Approving Authority00Approving Authority000024561807997190Approving Authority00Approving Authority00003742055768286512.? ? 0012.? ? 39611307663815003961130788289000000041421057654290Cleared for Processing00Cleared for Processing000041421057873365Request a Character Evaluation00Request a Character Evaluation000059232807711440Approving Authority00Approving Authority5408930771143900000054279807720965Date00Date000054375057978140Date00Date5418455797813900000059423307978140Approving Authority00Approving Authority00002082806797040CAUTION - PENALTIES FOR FALSE STATEMENTS:00CAUTION - PENALTIES FOR FALSE STATEMENTS:000027419306806565Knowingly making a false statement on this form is a violation of Federal law and could result in criminal00Knowingly making a false statement on this form is a violation of Federal law and could result in criminal00002082806911340prosecution, significant civil penalties, and a denial of your loan, surety bond, or other program participation.? A false statement is punishable under 18 USC 1001 and 357100prosecution, significant civil penalties, and a denial of your loan, surety bond, or other program participation.? A false statement is punishable under 18 USC 1001 and 357100002082807282815Signature00Signature00001416058740140SBA 912 (2-2013)? SOP 5010.4 Previous Edition Obsolete00SBA 912 (2-2013)? SOP 5010.4 Previous Edition Obsolete00001701808235315Please Note:? The estimated burden hours for completion of this form is 15 minutes per response.? You will not be required to respond to any collection of information unless00Please Note:? The estimated burden hours for completion of this form is 15 minutes per response.? You will not be required to respond to any collection of information unless00001606558425815Washington D.C. 20416 and Desk Officer for the Small Business Administration, Office of Management and Budget, New Executive Office Building, Room 10202, 00Washington D.C. 20416 and Desk Officer for the Small Business Administration, Office of Management and Budget, New Executive Office Building, Room 10202, 00001606558521065Washington, D.C. 20503.? OMB Approval 3245-0178.? 00Washington, D.C. 20503.? OMB Approval 3245-0178.? 000035515557282815Title00Title000060566307273290Date00Date3513454726376500601852972637650000007702553501390Present00Present372300481915003723004108204000000035515553720465Address:00Address:00002463804606290YOU MUST INITIAL YOUR RESPONSES TO QUESTIONS 5,7,8 AND 9.00YOU MUST INITIAL YOUR RESPONSES TO QUESTIONS 5,7,8 AND 9.00002463804815840IF YOU ANSWER "YES" TO 7, 8, OR 9, FURNISH DETAILS ON A SEPARATE SHEET.? INCLUDE DATES, LOCATION, FINES, SENTENCES, WHETHER00IF YOU ANSWER "YES" TO 7, 8, OR 9, FURNISH DETAILS ON A SEPARATE SHEET.? INCLUDE DATES, LOCATION, FINES, SENTENCES, WHETHER00004368806635115for the purpose of determining my eligibility for programs authorized by the Small Business Act, and the Small Business Investment Act.00for the purpose of determining my eligibility for programs authorized by the Small Business Act, and the Small Business Investment Act.00001797057520940Agency Use Only00Agency Use Only0000208280768286511.? ? 0011.? ? 00001701808330565it displays a currently valid OMB approval number.? Comments on the burden should be sent to U.S. Small Business Administration, Chief, AIB, 409 3rd St. S.W.,00it displays a currently valid OMB approval number.? Comments on the burden should be sent to U.S. Small Business Administration, Chief, AIB, 409 3rd St. S.W.,00005923280-137160OMB APPROVAL NO. 3245-017800OMB APPROVAL NO. 3245-0178361822975304650000007035805939790Yes00Yes00007131056406515Yes00Yes000011703055939790No00No000011798306406515No00No00001987557025640by imprisonment of not more than five years and/or a fine of up to $250,000; under 15 USC 645 by imprisonment of not more than two years and/or a fine of not more than 00by imprisonment of not more than five years and/or a fine of up to $250,000; under 15 USC 645 by imprisonment of not more than two years and/or a fine of not more than 00001987557139940$5,000; and, if submitted to a Federally insured institution, under 18 USC 1014 by imprisonment of not more than twenty years and/or a fine of not more than $1,000,000.00$5,000; and, if submitted to a Federally insured institution, under 18 USC 1014 by imprisonment of not more than twenty years and/or a fine of not more than $1,000,000.3723005232981400372300526536640000002940052139315000000189230122491500000018923013868400000001892301539240000000399923024631650000004008755377761500000024180804168140000000751205365379000000075120538252400000003999230395859000000037706301196340Denver, Colorado00Denver, Colorado0000387921515011400000002273302796540Community Economic Development Company Of Colorado00Community Economic Development Company Of Colorado000022733029489401175 Osage Street, Suite 110001175 Osage Street, Suite 11000002273303082290Denver, CO? 80204-340000Denver, CO? 80204-34000000294005231076500000029400524822150000002418080399669000000030372051996440Years Used00Years Used00003037205230124000000030372052472690000000382778073494900000006161405-32385Expiration Date:04/30/201600Expiration Date:04/30/201684645558635890000001606558616315of your application; send forms to the address provided by your lender or SBA representative.00of your application; send forms to the address provided by your lender or SBA representative.59328053206114000000381825517106902.? Give the percentage of ownership or stock002.? Give the percentage of ownership or stock0000000039611301901190concern or the development company00concern or the development company000061614051701165Social Security No.00Social Security No.61233041682115000000625665518630900000005546090187261500000038087302834640If no, are you a LawfulPermanent resident alien:00If no, are you a LawfulPermanent resident alien:49041052929890005361305292989000000050279302939415YES00YES000054946552939415NO00NO00003742055787336513.? ? 0013.? ? 000037801558101965(Required whenever 7,8 or 9 are answered "yes" even if cleared for processing.)00(Required whenever 7,8 or 9 are answered "yes" even if cleared for processing.)00001027430558736500000010369555930265000000104648063874650000003780155262890assessment of program eligibility.? Please reference SBA Regulations and00assessment of program eligibility.? Please reference SBA Regulations and00003780155377190Standard Operating Procedures if you have any questions about who must00Standard Operating Procedures if you have any questions about who must00003780155605790SBA's Answer Desk at 1-800-U-ASK-SBA (1-800-827-5722), or check SBA's00SBA's Answer Desk at 1-800-U-ASK-SBA (1-800-827-5722), or check SBA's00003780155720090website at .00website at .00002463804949190MISDEMEANOR OR FELONY, DATES OF PAROLE/PROBATION, UNPAID FINES OR PENALTIES, NAME(S) UNDER WHICH CHARGED, AND ANY00MISDEMEANOR OR FELONY, DATES OF PAROLE/PROBATION, UNPAID FINES OR PENALTIES, NAME(S) UNDER WHICH CHARGED, AND ANY00002463805082540OTHER PERTINENT INFORMATION.? AN ARREST OR CONVICTION RECORD WILL NOT NECESSRILY DISQUALIFY YOU; HOWEVER,00OTHER PERTINENT INFORMATION.? AN ARREST OR CONVICTION RECORD WILL NOT NECESSRILY DISQUALIFY YOU; HOWEVER,00002463805215890UNTRUTHFUL ANSWER WILL CAUSE YOUR APPLICATION TO BE DENIED AND SUBJECT YOU TO OTHER PENALTIES AS NOTED BELOW.00UNTRUTHFUL ANSWER WILL CAUSE YOUR APPLICATION TO BE DENIED AND SUBJECT YOU TO OTHER PENALTIES AS NOTED BELOW.000023799805615940INITIALS:? _______________________00INITIALS:? _______________________000023799805920740INITIALS:? _______________________00INITIALS:? _______________________000023799806377940INITIALS:? _______________________00INITIALS:? _______________________00003780155491490submit this form and where to submit it.? For further information, please call00submit this form and where to submit it.? For further information, please call000054946552739390INITIALS:? _______________________00INITIALS:? _______________________00004866005720090DO NOT SEND COMPLETED FORMS TO OMB as00DO NOT SEND COMPLETED FORMS TO OMB as00003780155834390this will delay the processing of your application; send forms to the address00this will delay the processing of your application; send forms to the address00003780155948690provided by your lender or SBA representative.00provided by your lender or SBA representative.000024466558521065DO NOT SEND COMPLETED FORMS TO OMB as this will delay the processing00DO NOT SEND COMPLETED FORMS TO OMB as this will delay the processing00002730534290007152005882586530036540581495900065405-1371600046355-1752600074930-146686004635561531400646430190118900236855643890I authorize SBA/Lender to make inquiries as necessary to verify the accuracy of the statements made and to determine my creditworthiness.00I authorize SBA/Lender to make inquiries as necessary to verify the accuracy of the statements made and to determine my creditworthiness.74930767715CERTIFICATION: (to be completed by each person submitting the information requested on this form)00CERTIFICATION: (to be completed by each person submitting the information requested on this form)939801015365By signing this form, I certify under penalty of criminal prosecution that all information on this form and any additional supporting information submitted00By signing this form, I certify under penalty of criminal prosecution that all information on this form and any additional supporting information submitted1035051739265Signature00Signature42849802177415Social Security Number:00Social Security Number:1892308187690PLEASE NOTE:00PLEASE NOTE:10274308197215The estimated average burden hours for the completion of this form is 1.5 hours per response. If you have questions or comments 00The estimated average burden hours for the completion of this form is 1.5 hours per response. If you have questions or comments 10274308311515concerning this estimate or any other aspect of this information, please contact Chief, Administrative Branch, U.S. Small Business00concerning this estimate or any other aspect of this information, please contact Chief, Administrative Branch, U.S. Small Business10274308435340Administration, Washington, D.C. 20416, and Clearance Office, Paper Reduction Project (3245-0188), Office of Management and Budget,00Administration, Washington, D.C. 20416, and Clearance Office, Paper Reduction Project (3245-0188), Office of Management and Budget,93980-118110Section 8.?? Life Insurance Held.00Section 8.?? Life Insurance Held.42373551739265Date:00Date:103505342900055327552205990006750052205990001913255-118110(Give face amount and cash surrender value of policies - name of insurance company and beneficiaries)00(Give face amount and cash surrender value of policies - name of insurance company and beneficiaries)21513808549640PLEASE DO NOT SEND FORMS TO OMB.00PLEASE DO NOT SEND FORMS TO OMB.7493087248900939801129665with this form is true and complete to the best of my knowledge. I understand that SBA or its participating Lenders, or Certified Development Companies00with this form is true and complete to the best of my knowledge. I understand that SBA or its participating Lenders, or Certified Development Companies939801243965will rely on this information when making decisions regarding an application for a loan from SBA or an SBA Participating Lender, or for participation in00will rely on this information when making decisions regarding an application for a loan from SBA or an SBA Participating Lender, or for participation in939801358265the SBA 8(a) Business Development (BD) program.00the SBA 8(a) Business Development (BD) program.10274308549640Washington, D.C. 20503.00Washington, D.C. 20503.939803577590NOTICE TO LOAN APPLICANTS: CRIMINAL PENALTIES AND ADMINISTRATIVE REMEDIES FOR FALSE STATEMENTS:00NOTICE TO LOAN APPLICANTS: CRIMINAL PENALTIES AND ADMINISTRATIVE REMEDIES FOR FALSE STATEMENTS:675005368236400939803777615Knowingly making a false statement on this form is a violation of Federal law and could result in criminal prosecution, significant civil penalties, and a00Knowingly making a false statement on this form is a violation of Federal law and could result in criminal prosecution, significant civil penalties, and a939803891915denial of your loan. A false statement is punishable under 18 U.S.C. §§ 1001 and 3571 by imprisonment of not more than five years and/or a fine of up to00denial of your loan. A false statement is punishable under 18 U.S.C. §§ 1001 and 3571 by imprisonment of not more than five years and/or a fine of up to939804006215$250,000; under 15 U.S.C. § 645 by imprisonment of not more than two years and/or a fine of not more than $5,000; and, if submitted to a Federally00$250,000; under 15 U.S.C. § 645 by imprisonment of not more than two years and/or a fine of not more than $5,000; and, if submitted to a Federally939804120515insured institution, a false statement is punishable under 18 U.S.C. § 1014 by imprisonment of not more than 30 years and/or a fine of not more than00insured institution, a false statement is punishable under 18 U.S.C. § 1014 by imprisonment of not more than 30 years and/or a fine of not more than939804234815$1,000,000.00$1,000,000.939804549140NOTICE TO APPLICANTS OR PARTICIPANTS IN THE 8(a) BD PROGRAM: CRIMINAL PENALTIES AND ADMINISTRATIVE REMEDIES FOR00NOTICE TO APPLICANTS OR PARTICIPANTS IN THE 8(a) BD PROGRAM: CRIMINAL PENALTIES AND ADMINISTRATIVE REMEDIES FOR684530465391400939804663440FALSE STATEMENTS:00FALSE STATEMENTS:939804882515Any person who misrepresents a business concern's status as an 8(a) Program participant or SDB concern, or makes any other false statement in order00Any person who misrepresents a business concern's status as an 8(a) Program participant or SDB concern, or makes any other false statement in order939804996815to influence the 8(a) certification or other review process in any way (e.g., annual review, eligibility review), shall be: (1) Subject to fines and imprisonment00to influence the 8(a) certification or other review process in any way (e.g., annual review, eligibility review), shall be: (1) Subject to fines and imprisonment939805111115of up to 5 years, or both, as stated in Title 18 U.S.C. § 1001; (2) subject to fines of up to $500,000 or imprisonment of up to 10 years, or both, as stated in00of up to 5 years, or both, as stated in Title 18 U.S.C. § 1001; (2) subject to fines of up to $500,000 or imprisonment of up to 10 years, or both, as stated in939805225415Title 15 U.S.C. § 645; (3) Subject to civil and administrative remedies, including suspension and debarment; and (4) Ineligible for participation in00Title 15 U.S.C. § 645; (3) Subject to civil and administrative remedies, including suspension and debarment; and (4) Ineligible for participation in939805339715programs conducted under the authority of the Small Business Act.00programs conducted under the authority of the Small Business Act.6464302339339001035052177415Print Name00Print Name550418023393390055041801901189006464302872739001035052710815Signature00Signature42849803148965Social Security Number:00Social Security Number:42373552710815Date:00Date:55327553177540006750053177540006464303310889001035053148965Print Name00Print Name550418033108890055041802872739004635534823390027305342900082558825865SBA Form 413 (05-12)00SBA Form 413 (05-12)9512308825865Previous Editions Obsolete00Previous Editions Obsolete00000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000-29845-2063750082557892415008255698754000-127041681400067500510344150000005932805-156210OMB Approval No. 3245-018800OMB Approval No. 3245-0188000093980643890U.S SMALL BUSINESS ADMINISTRATION00U.S SMALL BUSINESS ADMINISTRATION00005075555567690As of00As of5351780691514006418580691514000000570230805815Complete this form for: (I) each proprietor; (2) general partner; (3) managing member of a limited liability company (LLC); (4) each owner of 20% or more00Complete this form for: (I) each proprietor; (2) general partner; (3) managing member of a limited liability company (LLC); (4) each owner of 20% or more0000579755920115of the equity of the Applicant (including the assets of the owner's spouse and any minor children); and (5) any person providing a guaranty on the loan.00of the equity of the Applicant (including the assets of the owner's spouse and any minor children); and (5) any person providing a guaranty on the loan.0000749303158490Name00Name82553377564000000749303425190Residence Address00Residence Address-12703625214000000654053691890City, State, & Zip Code00City, State, & Zip Code82553891914000000654053968115Business Name of Applicant/Borrower00Business Name of Applicant/Borrower000014655804225290ASSETS00ASSETS000051327054234815LIABILITIES00LIABILITIES3522979418719000000028848054282440(Omit Cents)00(Omit Cents)000065328804282440(Omit Cents)00(Omit Cents)0000368304511040Cash on hand & in Banks 00Cash on hand & in Banks 000035610804511040Accounts Payable?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .? ?? 00Accounts Payable?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .? ?? 59613804758689000000368304653915Savings Accounts? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .00Savings Accounts? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .000012750804511040.?? .?? .?? .?? .?? .?? .?? .00.?? .?? .?? .?? .?? .?? .?? .2303780461581400230378047586890023037804901564000000368305073015Accounts & Notes Receivable.?? .?? .?? .?? .?? .?? .? ?? 00Accounts & Notes Receivable.?? .?? .?? .?? .?? .?? .? ?? 000021894804511040$00$000021894804653915$00$000021894804796790$00$23037805177789000000654055330190Life Insurance-Cash Surrender Value Only00Life Insurance-Cash Surrender Value Only00001130305425440? ?? (Complete Section 8) 00? ?? (Complete Section 8) 000021894805330190$ 00$ 23037805434964000000654055568315Stocks and Bonds? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? 00Stocks and Bonds? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? 230378056730890000002654305682615(Describe in Section 3)00(Describe in Section 3)0000368305844540Real Estate .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? . 00Real Estate .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? . 00002654305977890(Describe in Section 4)00(Describe in Section 4)000021894805854065$00$23037805958839000000368306111240Automobile-Total Present Value? .? .?? .?? .?? .?? .00Automobile-Total Present Value? .? .?? .?? .?? .?? .000021894806111240$00$23037806216014000000368306416040Other Personal Property .?? .?? .?? .?? .?? .?? .?? .?? .00Other Personal Property .?? .?? .?? .?? .?? .?? .?? .?? .000019608806416040? ? ? ? $00? ? ? ? $230378065208140000002654306530340(Describe in Section 5)00(Describe in Section 5)0000368306635115Other Assets? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .? ? 00Other Assets? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .? ? 230378067398890000002654306749415(Describe in Section 5)00(Describe in Section 5)000017418056816090Total? ? ? 00Total? ? ? 000021894806825615$00$2313305691133900000035610804653915Notes Payable to Banks and Others.?? .?? .?? .? .?? .? ? 00Notes Payable to Banks and Others.?? .?? .?? .? .?? .? ? 5961380504443900000035896554939665Installment Account (Auto)? .?? .?? .?? .?? .?? .?? .?? .?? .?? 00Installment Account (Auto)? .?? .?? .?? .?? .?? .?? .?? .?? .?? 5961380533018900000036563305082540? ? Mo. Payments00? ? Mo. Payments4589780518731400000035896555225415Installment Account (other)00Installment Account (other)000037706305368290Mo. Payments00Mo. Payments4589780547306400000047898055225415.?? .?? .?? .?? .?? .?? .?? .?? .?? 00.?? .?? .?? .?? .?? .?? .?? .?? .?? 5961380561593900000035896555511165Loans on Life Insurance? .?? .?? .?? .?? .?? .?? .?? .?? .?? .? ? ? ? 00Loans on Life Insurance? .?? .?? .?? .?? .?? .?? .?? .?? .?? .? ? ? ? 5961380575881400000035896555654040Mortgages on Real Estate?? .?? .?? .?? .?? .?? .?? .? ? .?? .? ? ? 00Mortgages on Real Estate?? .?? .?? .?? .?? .?? .?? .? ? .?? .? ? ? 5961380604456400000035991805796915? ? ? (Describe in Section 4)00? ? ? (Describe in Section 4)000035896555939790Unpaid Taxes?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .? ? ?? 00Unpaid Taxes?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .? ? ?? 5961380633031400000035991806082665? ? ? (Describe in Section 6)00? ? ? (Describe in Section 6)000035896556225540Other Liabilities? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .? .?? .?? .? ? ? 00Other Liabilities? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .? .?? .?? .? ? ? 5961380675893900000037706306358890(Describe in Section 7)00(Describe in Section 7)000035896556511290Total Liabilities? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .? .? ? ? 00Total Liabilities? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .? .? ? ? 5961380461581400000035896556654165Net Worth? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .? .?? .?? .?? 00Net Worth? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .? .?? .?? .?? 5961380661606400000058470806806565$00$5961380691133900000053994056797040Total? 00Total? 0000558807035165Section 1. Source of Income? 00Section 1. Source of Income? 0000177807254240Salary?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .? ? ? ? 00Salary?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .? ? ? ? 23037807359014000000177807397115Net Investment Income .?? .?? .?? .?? .?? .?? .?? .?? .00Net Investment Income .?? .?? .?? .?? .?? .?? .?? .?? .23037807501889000000177807539990Real Estate Income?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .? ? ? ? 00Real Estate Income?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .? ? ? ? 23037807644764000000177807682865Other Income (Describe Below)*? .?? .?? .?? .?? .? ? ?? 00Other Income (Describe Below)*? .?? .?? .?? .?? .? ? ?? 2303780778763900000035610807254240As Endorser or Co-Maker? .?? .?? .?? .?? .?? .?? .?? .? ? .? ? ? ?? 00As Endorser or Co-Maker? .?? .?? .?? .?? .?? .?? .?? .? ? .? ? ? ?? 5961380750188900000035610807397115Legal Claims & Judgments .?? .?? .?? .?? .?? .?? .?? .? ? .? ?? 00Legal Claims & Judgments .?? .?? .?? .?? .?? .?? .?? .? ? .? ?? 5961380764476400000035610807539990Provision for Federal Income Tax? .?? .?? .?? .?? .? ? .00Provision for Federal Income Tax? .?? .?? .?? .?? .? ? .5961380778763900000035610807682865Other Special Debt? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .? ? ? ?? 00Other Special Debt? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .?? .? ? ? ?? 59613807359014000000273057930515Description of Other Income in Section 1.00Description of Other Income in Section 1.82558597264000000368308616315*Alimony or child support payments need not be disclosed in "Other Income" unless it is desired to have such payments counted toward total income.00*Alimony or child support payments need not be disclosed in "Other Income" unless it is desired to have such payments counted toward total income.000058185054663440$00$0000562800564065150000005742305669226500000058185056654165$00$00005275580666369000000021894805073015$00$000021894805854065000000582803049491900000002303780451104000000021894804653915000000218948047967900000002189480533019000000020751805854065000000368304796790IRA or Other Retirement Account?? .?? .?? .?? .?? .00IRA or Other Retirement Account?? .?? .?? .?? .?? .0000-29845540639000000035706054787265? ? ?? (Describe in Section 2)00? ? ?? (Describe in Section 2)000035801307044690Contingent Liabilities00Contingent Liabilities000021894805568315$00$000021894806635115$00$000058470804511040$00$000058470805511165$00$000058470805654040$00$000058470805939790$00$000058470806225540$00$000058470806511290$00$000058470807254240$00$000058470807539990$00$000021894807682865$00$000021894807254240$00$000058470807682865$00$000058470807397115$00$000021894807539990$00$000021894807406640$00$000058470804939665$00$000058470805225415$00$00002446655167640PERSONAL FINANCIAL STATEMENT00PERSONAL FINANCIAL STATEMENT-1270697801400000036830-15621000000045135805082540$00$000045135805368290$00$000048945803168015Business Phone00Business Phone000049041053425190Residence Phone00Residence Phone000011988803453765000000119888037299900000005799455343471500000022409154463415000000224091546062900000002240915475869000000022409155034915000000224091552920900000002240915552069000000022409155806440000000224091560636150000002240915637794000000022313906597015000000223139067779900000002221865720661500000022218657349490000000222186575018900000002231390765429000000059080404463415000000590804046253400000005908040488251500000059270905168265000000592709054540150000004517390502539000000045078655311140000000591756556254650000005908040588264000000058985156168390000000591756564636650000005917565662559000000059080406777990000000586994071970900000005869940733996500000058699407492365000000586994076352400000001778081210150000001913255396811500000054165532537400000005789930318706500000054165530918150000005847080-51435EXPIRATION DATE: 09/30/201400EXPIRATION DATE: 09/30/201400006323330567690,00,000071310511391907(a) loans -007(a) loans -00007131051348740ALL Disaster loans -00ALL Disaster loans -000011131551443990applicants who are individuals claiming social and economic disadvantaged status and their spouses00applicants who are individuals claiming social and economic disadvantaged status and their spouses67500516535400000007607301691640Mail to the following address, if your firm is00Mail to the following address, if your firm is00007607301805940located in one of the states below:00located in one of the states below:00007607301948815US Small Business Administration00US Small Business Administration00007607302063115DPCE Central Office Duty Station00DPCE Central Office Duty Station00007607302177415Parkview Towers00Parkview Towers000076073022917151150 First Avenue001150 First Avenue0000760730240601510th Floor, Suite 100I0010th Floor, Suite 100I00007607302520315King of Prussia, PA 1940600King of Prussia, PA 1940600007607302663190MA, ME, NH, CT, VT, RI, NY, PR (Puerto Rico), VI (US Virgin00MA, ME, NH, CT, VT, RI, NY, PR (Puerto Rico), VI (US Virgin00007607302777490Islands), NJ, PA, MD, VA, WV, DC, DE, GA, AL,NC, SC, MS,00Islands), NJ, PA, MD, VA, WV, DC, DE, GA, AL,NC, SC, MS,00007607302891790FL, KY, TN00FL, KY, TN3618229166306500000037325301691640Mail to the following address, if your firm is00Mail to the following address, if your firm is000037325301805940located in one of the states below:00located in one of the states below:000037325302044065Small Business Administration00Small Business Administration000037325302148840Division of Program Certification and Eligibility00Division of Program Certification and Eligibility000037325302272665455 Market Street, 6th Floor00455 Market Street, 6th Floor000037325302396490San Francisco, CA 9410500San Francisco, CA 94105000036753802653665IL, OH, MI, IN, MN, WI, TX, NM, AR, LA, OK, MO, IA, NE, KS, CO,00IL, OH, MI, IN, MN, WI, TX, NM, AR, LA, OK, MO, IA, NE, KS, CO,675005193928900675005265366400825530537140000001130304901565? ?? (Complete Section 5) 00? ?? (Complete Section 5) 00001130305177790? ?? (Complete Section 5) 00? ?? (Complete Section 5) 00002654306206490(Describe in Section 5, and include00(Describe in Section 5, and include00002654306320790Year/Make/Model)00Year/Make/Model)000082558787765SBA Form 413 (05-12)00SBA Form 413 (05-12)000071520058787765100100009512308787765Previous Editions Obsolete00Previous Editions Obsolete000036753802767965WY, ND, MT, UT, SD, CA, HI, GU (GUAM), NV, AZ, WA, AK, ID00WY, ND, MT, UT, SD, CA, HI, GU (GUAM), NV, AZ, WA, AK, ID000036753802891790OR00OR00007131051043940Return completed form to:00Return completed form to:000012274551139190to the lender processing the SBA application;00to the lender processing the SBA application;00007131051243965504 loans -00504 loans -000012179301243965to the Certified Development Company processing the SBA application;00to the Certified Development Company processing the SBA application;000071310514439908(a)/BD -008(a)/BD -000016084551348740to the Disaster Processing and Disbursement Center at 14925 Kingsport Road, Fort Worth, TX 76155-2243; and00to the Disaster Processing and Disbursement Center at 14925 Kingsport Road, Fort Worth, TX 76155-2243; and00007131051539240- electronically at or send hard copy with paper application to either of the two following offices listed below:00- electronically at or send hard copy with paper application to either of the two following offices listed below:0000273053429000558803206115006540535490150065405784479000654057092315000000939807111365Section 6.? Unpaid Taxes.00Section 6.? Unpaid Taxes.558806254115006540518821400046355-133350065405319658900749306235064006540570827890065405784478900749302053589006540525203140055880274891400558802977514000000558801901190Section 3. 00Section 3. 1122679206311500311340420631150041706792053590005199379206311500623760420631150018846803434714007493035490140018846803749039001884680427291400188468044729390018846804663439001884680487298900188468053968640018846805606414001884680580643900188468060255140030467293434715003684904356806500548512935585400000006273801901190Stocks and Bonds. (Use attachments if necessary.? Each attachment must be identified as a part of this statement and signed).00Stocks and Bonds. (Use attachments if necessary.? Each attachment must be identified as a part of this statement and signed).00001511302110740? Number of Shares00? Number of Shares000015417802101215Name of Securities00Name of Securities000043421302053590Market Value00Market Value4294504228219000000042278302158365Quotation/Exchange00Quotation/Exchange000055803802044065Date of00Date of00005323205207264000000052660552158365Quotation/Exchange00Quotation/Exchange000064662052091690Total Value00Total Value00001035053215640Section 4.?? Real Estate Owned.?? (List each parcel separately. Use attachments if necessary. Each attachment must be identified00Section 4.?? Real Estate Owned.?? (List each parcel separately. Use attachments if necessary. Each attachment must be identified000017799053310890as a part of this statement and signed).00as a part of this statement and signed).000025038053434715Property A00Property A000042945053434715Property B00Property B000060947303434715Property C00Property C00001035053577590Type of Real Estate (e.g. Primary00Type of Real Estate (e.g. Primary0000749303987165Address 00Address 0000844554320540Date Purchased00Date Purchased00001035054501515Original Cost00Original Cost0000939804692015Present Market Value00Present Market Value00001320804977765Name &00Name &00001130305092065Address of Mortgage Holder00Address of Mortgage Holder0000939805425440Mortgage Account Number00Mortgage Account Number00001035055644515Mortgage Balance00Mortgage Balance00001035055854065Amount of Payment per Month/Year00Amount of Payment per Month/Year00001035056073140Status of Mortgage00Status of Mortgage00001225556263640Section 5. Other Personal Property and Other Assets.00Section 5. Other Personal Property and Other Assets.000030181556368415amount of lien, terms of payment, and if delinquent, describe delinquency).00amount of lien, terms of payment, and if delinquent, describe delinquency).0000939807863840Section 7.?? Other Liabilities.00Section 7.?? Other Liabilities.000034944052120265Cost00Cost00008826523488650000001151255233934000000088265256794000000097790279654000000097790302514000000011512552567940000000115125527965400000001151255302514000000030505402358390000000305054025869900000003050540280606500000030505403025140000000409829023488650000004098290258699000000040982902815590000000409829030346650000006146165234886500000061461652577465000000614616528060650000006146165302514000000011303065208150000001130307273290000000103505801624000000019132553577590000000371348035775900000005523230357759000000019132553930015000000370395539300150000005513705393954000000019132554491990000000371348045015150000005513705450151500000019227804701540000000372300546920150000005513705470154000000019037304911090000000190373050730150000003713480490156500000037134805073015000000551370548920400000005513705507301500000019037305434965000000370395554349650000005513705542544000000019132555644515000000370395556540400000005513705563499000000019132555854065000000371348058635900000005523230586359000000019227806063615000000371348060731400000005513705607314000000019132554101465000000370395541014650000005513705411099000000019037305234940000000371348052349400000005513705523494000000030086306263640(Describe, and if any is pledged as security, state name and address of lien holder,00(Describe, and if any is pledged as security, state name and address of lien holder,000016751307111365(Describe in detail, as to type, to whom payable, when due, amount, and to what property, if any, a tax lien attaches).00(Describe in detail, as to type, to whom payable, when due, amount, and to what property, if any, a tax lien attaches).000016751307863840(Describe in detail).00(Describe in detail).188467934347150055880152400065405152390000009398024765Section 2.? Notes Payable to Bank and Others.?? (Use attachments if necessary. Each attachment must be identified as a part of00Section 2.? Notes Payable to Bank and Others.?? (Use attachments if necessary. Each attachment must be identified as a part of00002580005139065this statement and signed).00this statement and signed).65405281939000000522605367665Name and Address of Noteholders (s)00Name and Address of Noteholders (s)25133292819400000002713355300990Original 00Original 00002656205415290? Balance00? Balance31991292819400000003351530300990Current 00Current 00003351530415290Balance00Balance38849292819400000003942080300990Payment00Payment00003961130405765Amount00Amount44088042819400000004637405300990Frequency00Frequency00004599305405765(monthly,etc.)00(monthly,etc.)53232042819400000005656580300990How Secured or Endorsed00How Secured or Endorsed00005847080396240Type of Collateral00Type of Collateral558801082039005588013487390055880161543900654058153390000009398057721500000093980701040000000844558439150000008445596774000000084455111061500000084455123444000000084455137731500000084455150114000000093980165354000000093980177736500000024504656438900000002450465901065000000245046511582400000002450465143446500000024504651701165000000312674064389000000031267409010650000003126740115824000000031267401424940000000312674017011650000003860165643890000000386016590106500000038601651167765000000386016514344650000003850640169164000000054089306248400000005418455901065000000541845511677650000005418455143446500000054279801701165000000456120563436500000045707308915400000004570730116776500000045612051424940000000458025517011650000001035053691890Residence, Other Residence, Rental00Residence, Other Residence, Rental00001035053806190Property, Land, etc.)00Property, Land, etc.)000082558816340SBA Form 413 (05-12)00SBA Form 413 (05-12)000071520058816340200200009512308816340Previous Editions Obsolete00Previous Editions Obsolete00002730534290006540581495900065405-1371600046355-1752600074930-1466860046355615314006464301901189000000236855643890I authorize SBA/Lender to make inquiries as necessary to verify the accuracy of the statements made and to determine my creditworthiness.00I authorize SBA/Lender to make inquiries as necessary to verify the accuracy of the statements made and to determine my creditworthiness.000074930767715CERTIFICATION: (to be completed by each person submitting the information requested on this form)00CERTIFICATION: (to be completed by each person submitting the information requested on this form)0000939801015365By signing this form, I certify under penalty of criminal prosecution that all information on this form and any additional supporting information submitted00By signing this form, I certify under penalty of criminal prosecution that all information on this form and any additional supporting information submitted00001035051739265Signature00Signature000042849802177415Social Security Number:00Social Security Number:00001892308187690PLEASE NOTE:00PLEASE NOTE:000010274308197215The estimated average burden hours for the completion of this form is 1.5 hours per response. If you have questions or comments 00The estimated average burden hours for the completion of this form is 1.5 hours per response. If you have questions or comments 000010274308311515concerning this estimate or any other aspect of this information, please contact Chief, Administrative Branch, U.S. Small Business00concerning this estimate or any other aspect of this information, please contact Chief, Administrative Branch, U.S. Small Business000010274308435340Administration, Washington, D.C. 20416, and Clearance Office, Paper Reduction Project (3245-0188), Office of Management and Budget,00Administration, Washington, D.C. 20416, and Clearance Office, Paper Reduction Project (3245-0188), Office of Management and Budget,000093980-118110Section 8.?? Life Insurance Held.00Section 8.?? Life Insurance Held.000042373551739265Date:00Date:0000103505342900000005532755220599000000067500522059900000001913255-118110(Give face amount and cash surrender value of policies - name of insurance company and beneficiaries)00(Give face amount and cash surrender value of policies - name of insurance company and beneficiaries)000021513808549640PLEASE DO NOT SEND FORMS TO OMB.00PLEASE DO NOT SEND FORMS TO OMB.000082558825865SBA Form 413 (05-12)00SBA Form 413 (05-12)000071520058825865300300009512308825865Previous Editions Obsolete00Previous Editions Obsolete74930872489000000939801129665with this form is true and complete to the best of my knowledge. I understand that SBA or its participating Lenders, or Certified Development Companies00with this form is true and complete to the best of my knowledge. I understand that SBA or its participating Lenders, or Certified Development Companies0000939801243965will rely on this information when making decisions regarding an application for a loan from SBA or an SBA Participating Lender, or for participation in00will rely on this information when making decisions regarding an application for a loan from SBA or an SBA Participating Lender, or for participation in0000939801358265the SBA 8(a) Business Development (BD) program.00the SBA 8(a) Business Development (BD) program.000010274308549640Washington, D.C. 20503.00Washington, D.C. 20503.0000939803577590NOTICE TO LOAN APPLICANTS: CRIMINAL PENALTIES AND ADMINISTRATIVE REMEDIES FOR FALSE STATEMENTS:00NOTICE TO LOAN APPLICANTS: CRIMINAL PENALTIES AND ADMINISTRATIVE REMEDIES FOR FALSE STATEMENTS:6750053682364000000939803777615Knowingly making a false statement on this form is a violation of Federal law and could result in criminal prosecution, significant civil penalties, and a00Knowingly making a false statement on this form is a violation of Federal law and could result in criminal prosecution, significant civil penalties, and a0000939803891915denial of your loan. A false statement is punishable under 18 U.S.C. §§ 1001 and 3571 by imprisonment of not more than five years and/or a fine of up to00denial of your loan. A false statement is punishable under 18 U.S.C. §§ 1001 and 3571 by imprisonment of not more than five years and/or a fine of up to0000939804006215$250,000; under 15 U.S.C. § 645 by imprisonment of not more than two years and/or a fine of not more than $5,000; and, if submitted to a Federally00$250,000; under 15 U.S.C. § 645 by imprisonment of not more than two years and/or a fine of not more than $5,000; and, if submitted to a Federally0000939804120515insured institution, a false statement is punishable under 18 U.S.C. § 1014 by imprisonment of not more than 30 years and/or a fine of not more than00insured institution, a false statement is punishable under 18 U.S.C. § 1014 by imprisonment of not more than 30 years and/or a fine of not more than0000939804234815$1,000,000.00$1,000,000.0000939804549140NOTICE TO APPLICANTS OR PARTICIPANTS IN THE 8(a) BD PROGRAM: CRIMINAL PENALTIES AND ADMINISTRATIVE REMEDIES FOR00NOTICE TO APPLICANTS OR PARTICIPANTS IN THE 8(a) BD PROGRAM: CRIMINAL PENALTIES AND ADMINISTRATIVE REMEDIES FOR6845304653914000000939804663440FALSE STATEMENTS:00FALSE STATEMENTS:0000939804882515Any person who misrepresents a business concern's status as an 8(a) Program participant or SDB concern, or makes any other false statement in order00Any person who misrepresents a business concern's status as an 8(a) Program participant or SDB concern, or makes any other false statement in order0000939804996815to influence the 8(a) certification or other review process in any way (e.g., annual review, eligibility review), shall be: (1) Subject to fines and imprisonment00to influence the 8(a) certification or other review process in any way (e.g., annual review, eligibility review), shall be: (1) Subject to fines and imprisonment0000939805111115of up to 5 years, or both, as stated in Title 18 U.S.C. § 1001; (2) subject to fines of up to $500,000 or imprisonment of up to 10 years, or both, as stated in00of up to 5 years, or both, as stated in Title 18 U.S.C. § 1001; (2) subject to fines of up to $500,000 or imprisonment of up to 10 years, or both, as stated in0000939805225415Title 15 U.S.C. § 645; (3) Subject to civil and administrative remedies, including suspension and debarment; and (4) Ineligible for participation in00Title 15 U.S.C. § 645; (3) Subject to civil and administrative remedies, including suspension and debarment; and (4) Ineligible for participation in0000939805339715programs conducted under the authority of the Small Business Act.00programs conducted under the authority of the Small Business Act.64643023393390000001035052177415Print Name00Print Name5504180233933900550418019011890064643028727390000001035052710815Signature00Signature000042849803148965Social Security Number:00Social Security Number:000042373552710815Date:00Date:00005532755317754000000067500531775400064643033108890000001035053148965Print Name00Print Name55041803310889005504180287273900463553482339000000273053429000PERSONAL RESUME FORMWe need to understand the background and management experience of the principals of the small business. Please attach resumes for any principals or key employees involved with the small business, or complete this form for each principal or key employee. Name: _____________________________________________________________________________Home Address: ______________________________________________________________________Phone: _____________________________Email: _______________________________________MILITARY:Branch of Military: _________________________________ From: ____________ To: ____________Rank at Dischrage: ________________________________ Honorable Discharge: ________________Job Description: ______________________________________________________________________EDUCATION (College or Technical Training):Name and Location: ___________________________________________________________________Dates Attended: ___________________ Major: ________________ Degree/Certificate: ___________Name and Location: ___________________________________________________________________Dates Attended: ___________________ Major: ________________ Degree/Certificate: ___________WORK EXPERIENCE:Company Name: __________________________________ From: ____________ To: ____________Title: ____________________________________________ City/State: ________________________Company Name: __________________________________ From: ____________ To: ____________Title: ____________________________________________ City/State: ________________________Company Name: __________________________________ From: ____________ To: ____________Title: ____________________________________________ City/State: ________________________00002463804206240applicant's income derives from any public assistance program, or because the applicant has in good faith exercised any right under the Consumer00applicant's income derives from any public assistance program, or because the applicant has in good faith exercised any right under the Consumer00002273301634490Occupational Safety and Health Act00Occupational Safety and Health Act000024657051634490(15 U.S.C. 651 et seq.)00(15 U.S.C. 651 et seq.)00002273301863090This legislation authorizes the Occupational Safety and Health Administration in the Department of Labor to require businesses to modify facilities00This legislation authorizes the Occupational Safety and Health Administration in the Department of Labor to require businesses to modify facilities00002273301996440and procedures to protect employees or pay penalty fees. In some instances the business can be forced to cease operations or be prevented from00and procedures to protect employees or pay penalty fees. In some instances the business can be forced to cease operations or be prevented from00002273302129790starting operations in a new facility. Therefore, in some instances SBA may require additional information from an applicant to determine whether00starting operations in a new facility. Therefore, in some instances SBA may require additional information from an applicant to determine whether00002273302263140the business will be in compliance with OSHA regulations and allowed to operate its facility after the loan is approved and disbursed.? Signing this00the business will be in compliance with OSHA regulations and allowed to operate its facility after the loan is approved and disbursed.? Signing this0000227330-41910Flood Disaster Protection Act00Flood Disaster Protection Act00002075180-32385(42 U.S.C. 4011)00(42 U.S.C. 4011)0000227330148590Regulations have been issued by the Federal Insurance Administration (FIA) and by SBA implementing this Act and its amendments. These00Regulations have been issued by the Federal Insurance Administration (FIA) and by SBA implementing this Act and its amendments. These0000227330281940regulations prohibit SBA from making certain loans in a FIA designated floodplain unless Federal flood insurance is purchased as a condition of the00regulations prohibit SBA from making certain loans in a FIA designated floodplain unless Federal flood insurance is purchased as a condition of the0000227330415290loan. Failure to maintain the required level of flood insurance makes the applicant ineligible for any future financial assistance from SBA under any00loan. Failure to maintain the required level of flood insurance makes the applicant ineligible for any future financial assistance from SBA under any0000227330548640program, including disaster assistance.00program, including disaster assistance.0000227330834390Executive Orders -- Floodplain Management and Wetland Protection00Executive Orders -- Floodplain Management and Wetland Protection00004342130834390(42 F.R. 26951 and 42 F.R. 26961)00(42 F.R. 26951 and 42 F.R. 26961)00002273301034415The SBA discourages any settlement in or development of a floodplain or a wetland. This statement is to notify all SBA loan applicants that such00The SBA discourages any settlement in or development of a floodplain or a wetland. This statement is to notify all SBA loan applicants that such00002273301167765actions are hazardous to both life and property and should be avoided. The additional cost of flood preventive construction must be considered in 00actions are hazardous to both life and property and should be avoided. The additional cost of flood preventive construction must be considered in 00002273301301115addition to the possible loss of all assets and investments in future floods.00addition to the possible loss of all assets and investments in future floods.00002463804777740Executive Order 11738 -- Environmental Protection00Executive Order 11738 -- Environmental Protection000033896304787265(38 F.R. 25161)00(38 F.R. 25161)00002749554996815The Executive Order charges SBA with administering its loan programs in a manner that will result in effective enforcement of the Clean Air Act, the00The Executive Order charges SBA with administering its loan programs in a manner that will result in effective enforcement of the Clean Air Act, the00002749555130165Federal Water Pollution Act and other environmental protection legislation. SBA must, therefore, impose conditions on some loans. By00Federal Water Pollution Act and other environmental protection legislation. SBA must, therefore, impose conditions on some loans. By00002749555263515acknowledging receipt of this form and presenting the application, the principals of all small businesses borrowing $ 100,000 or more in direct funds00acknowledging receipt of this form and presenting the application, the principals of all small businesses borrowing $ 100,000 or more in direct funds00002749555396865stipulate to the following:00stipulate to the following:000025590556826151.? That any facility used, or to be used, by the subject firm is not cited on the EPA List of Violating Facilities.001.? That any facility used, or to be used, by the subject firm is not cited on the EPA List of Violating Facilities.000025590558254902.? That subject firm will comply with all the requirements of Section 114 of the Clean Air Act (42 U.S.C. 7414) and Section 308? of the Water Act (33002.? That subject firm will comply with all the requirements of Section 114 of the Clean Air Act (42 U.S.C. 7414) and Section 308? of the Water Act (3300003987806111240Section 308 on the respective Acts, and all regulations and guidelines issued thereunder.00Section 308 on the respective Acts, and all regulations and guidelines issued thereunder.000025590562445903.? That subject firm will notify SBA of the receipt of any communication from the Director of the Environmental Protection Agency indicating003.? That subject firm will notify SBA of the receipt of any communication from the Director of the Environmental Protection Agency indicating00003987806377940that a facility utilized, or to be utilized, by subject firm is under consideration to be listed on the EPA list of violating facilities.00that a facility utilized, or to be utilized, by subject firm is under consideration to be listed on the EPA list of violating facilities.00002273308692515SBA Form 1244 (2-13) Previous Edition is Obsolete00SBA Form 1244 (2-13) Previous Edition is Obsolete00003987805977890U.S.C. 1318) relating to inspection, monitoring, entry, reports and information, as well as all other requirements specified in Section 114 and00U.S.C. 1318) relating to inspection, monitoring, entry, reports and information, as well as all other requirements specified in Section 114 and00002273302396490form as borrower is a certification that the OSA requirements that apply to the borrower's business have been determined and the borrower to the00form as borrower is a certification that the OSA requirements that apply to the borrower's business have been determined and the borrower to the00002273302529840best of its knowledge is in compliance.00best of its knowledge is in compliance.00002273302863215Civil Rights Legislation00Civil Rights Legislation00002273303053715All businesses receiving SBA financial assistance must agree not to discriminate in any business practice, including employment practices and services00All businesses receiving SBA financial assistance must agree not to discriminate in any business practice, including employment practices and services00002273303187065to the public, on the basis of categories cited in 13 C.F.R., Parts 112, 113, and 117 of SBA regulations. This includes making their goods and services00to the public, on the basis of categories cited in 13 C.F.R., Parts 112, 113, and 117 of SBA regulations. This includes making their goods and services00002273303320415available to handicapped clients or customers. All business borrowers will be required to display the "Equal Employment Opportunity Poster"00available to handicapped clients or customers. All business borrowers will be required to display the "Equal Employment Opportunity Poster"00002273303453765prescribed by SBA.00prescribed by SBA.00002463803758565Equal Credit Opportunity Act00Equal Credit Opportunity Act000020275553758565(15 U.S.C. 1691)00(15 U.S.C. 1691)00002463803958590The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion,00The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion,00002463804082415national origin, sex, marital status or age (provided that the applicant has the capacity to enter into a binding contract); because all or part of the00national origin, sex, marital status or age (provided that the applicant has the capacity to enter into a binding contract); because all or part of the00002463804330065Credit Protection Act. The Federal agency that administers compliance with the law concerning this creditor is the Federal Trade Commission, Equal00Credit Protection Act. The Federal agency that administers compliance with the law concerning this creditor is the Federal Trade Commission, Equal00002463804453890Credit Opportunity, Washington, D.C. 20580.00Credit Opportunity, Washington, D.C. 20580.00002749556739890Debt Collection Act of 1982 Deficit Reduction Act of 198400Debt Collection Act of 1982 Deficit Reduction Act of 1984000040278056730365(31 U.S.C. 3701 et seq. and other titles)00(31 U.S.C. 3701 et seq. and other titles)00002749557044690These laws require SBA to aggressively collect any loan payments which become delinquent. SBA must obtain your taxpayer identification number00These laws require SBA to aggressively collect any loan payments which become delinquent. SBA must obtain your taxpayer identification number00002749557178040when you apply for a loan. If you receive a loan and do not make payments as they come due, SBA may take one or more of the following actions:00when you apply for a loan. If you receive a loan and do not make payments as they come due, SBA may take one or more of the following actions:00005035557387590- Report the Status of your loan(s) to the credit bureaus00- Report the Status of your loan(s) to the credit bureaus00005035557539990- Hire a collection agency to collect your loan00- Hire a collection agency to collect your loan00005035557711440- Offset your income tax refund or other amounts due to you from the Federal Government00- Offset your income tax refund or other amounts due to you from the Federal Government00005035557863840- Suspend or debar you or your company from doing business with the Federal Government00- Suspend or debar you or your company from doing business with the Federal Government00005035558025765- Refer your loan to the Department of Justice or other attorneys for litigation00- Refer your loan to the Department of Justice or other attorneys for litigation00005035558187690- Foreclose on collateral or take other action permitted in the loan instruments.00- Foreclose on collateral or take other action permitted in the loan instruments.000036372808692515-9-00-9-000027305342900000002273302377440Agreement of Nonemployment of SBA Personnel00Agreement of Nonemployment of SBA Personnel00002273302558415I agree that if SBA approves this application, I will not for at least two years hire an employee or consult anyone who was employed by the SBA00I agree that if SBA approves this application, I will not for at least two years hire an employee or consult anyone who was employed by the SBA00002273302682240during the one year period prior to the disbursement of the debenture.00during the one year period prior to the disbursement of the debenture.00002273302967990Certification as to Payment for Financial Assistance00Certification as to Payment for Financial Assistance000018923024631650000002273303168015I certify: I have not paid anyone connected with the Federal government for help getting this financial assistance. I also agree to report to the SBA00I certify: I have not paid anyone connected with the Federal government for help getting this financial assistance. I also agree to report to the SBA00002273303301365Office of Inspector General, 409 Third Street S.W., Washington, D.C. 20416, any Federal government employee who offers in return for any type of00Office of Inspector General, 409 Third Street S.W., Washington, D.C. 20416, any Federal government employee who offers in return for any type of00002273303434715compensation to help get this application approved. I understand that I need not pay anybody to deal with SBA. I also understand that a Certified00compensation to help get this application approved. I understand that I need not pay anybody to deal with SBA. I also understand that a Certified00002273303568065Development Company may charge the applicant a percentage of the loan proceeds as set forth in SBA regulations as a fee for preparing and00Development Company may charge the applicant a percentage of the loan proceeds as set forth in SBA regulations as a fee for preparing and00002273304244340Certification as to Non-relocation00Certification as to Non-relocation00002463804463415Regulations issued by SBA prohibit the making of loans that will result in a significant increase of unemployment in any area of the country (13 CFR00Regulations issued by SBA prohibit the making of loans that will result in a significant increase of unemployment in any area of the country (13 CFR00002463804615815120.881 (a)). In the event that proceeds from this loan are used to provide a facility for relocation of the beneficiary small business concern (including00120.881 (a)). In the event that proceeds from this loan are used to provide a facility for relocation of the beneficiary small business concern (including00002463804768215any affiliate, subsidiary or other business entity under direct, indirect or common control), the undersigned certifies that such relocation will not00any affiliate, subsidiary or other business entity under direct, indirect or common control), the undersigned certifies that such relocation will not00002463804911090significantly increase unemployment in the area of the original location.00significantly increase unemployment in the area of the original location.00002273308663940SBA Form 1244 (2-13) Previous Edition is Obsolete00SBA Form 1244 (2-13) Previous Edition is Obsolete0000189230-2038350000002273303701415processing loan applications.? I agree to pay for or reimburse SBA for the cost of any surveys, title or mortgage examinations, appraisals, etc.,00processing loan applications.? I agree to pay for or reimburse SBA for the cost of any surveys, title or mortgage examinations, appraisals, etc.,0000227330-41910Immigration and Nationality Act 00Immigration and Nationality Act 00002560955-41910(8 U.S.C. 1001, et seq., as amended)00(8 U.S.C. 1001, et seq., as amended)0000227330158115If you are an alien who was in this country illegally since? before January 1, 1982, you may have been granted lawful temporary resident status by the 00If you are an alien who was in this country illegally since? before January 1, 1982, you may have been granted lawful temporary resident status by the 0000227330291465United States Citizenship and Immigration Services pursuant to the Immigration Reform and Control Act of 1986 (Pub. L. 99-603). For five years00United States Citizenship and Immigration Services pursuant to the Immigration Reform and Control Act of 1986 (Pub. L. 99-603). For five years0000227330424815from the date you are granted such status, you are not eligible for financial assistance from the SBA in the form of a loan or guaranty under Section00from the date you are granted such status, you are not eligible for financial assistance from the SBA in the form of a loan or guaranty under Section00002273305581657(a) of the Small Business Act unless you are disabled or a Cuban or Haitian entrant. When you sign this document, you are making the certification007(a) of the Small Business Act unless you are disabled or a Cuban or Haitian entrant. When you sign this document, you are making the certification0000227330691515that the Immigration Reform and Control Act of 1986 does not apply to you, or if it does apply, more than five years have elapsed since you have been 00that the Immigration Reform and Control Act of 1986 does not apply to you, or if it does apply, more than five years have elapsed since you have been 0000227330824865granted lawful temporary resident status pursuant to such 1986 legislation.00granted lawful temporary resident status pursuant to such 1986 legislation.00002273301253490Lead-Based Paint Poisoning Prevention Act00Lead-Based Paint Poisoning Prevention Act000029419551253490(42 U.S.C. 4821 et seq.)00(42 U.S.C. 4821 et seq.)00002273301463040Borrowers using SBA funds for the construction or rehabilitation of a residential structure are prohibited from using lead-based paint (as defined in00Borrowers using SBA funds for the construction or rehabilitation of a residential structure are prohibited from using lead-based paint (as defined in00002273301596390SBA regulations) on all interior surfaces, whether accessible or not, and exterior surfaces, such as stairs, decks, porches, railings, windows, and doors,00SBA regulations) on all interior surfaces, whether accessible or not, and exterior surfaces, such as stairs, decks, porches, railings, windows, and doors,00002273301729740which are readily accessible to children under 7 years of age. A "residential structure" is any home, apartment, hotel, motel, orphanage, boarding00which are readily accessible to children under 7 years of age. A "residential structure" is any home, apartment, hotel, motel, orphanage, boarding00002273301863090school, dormitory, day care center, extended care facility, college or other school housing, hospital, group practice or community facility and all 00school, dormitory, day care center, extended care facility, college or other school housing, hospital, group practice or community facility and all 00002273301996440other residential or institutional structures where persons reside.00other residential or institutional structures where persons reside.00002273303834765performed by non-SBA personnel provided that I have given my consent.00performed by non-SBA personnel provided that I have given my consent.00002273305311140Executive Order 12549 as amended by E.O. 12689, Debarment and Suspension and 2 CFR Part 270000Executive Order 12549 as amended by E.O. 12689, Debarment and Suspension and 2 CFR Part 2700000022733055206901.?? The prospective lower tier participant certifies, by submission of this loan application, that neither it nor its principals are presently debarred,001.?? The prospective lower tier participant certifies, by submission of this loan application, that neither it nor its principals are presently debarred,00003987805654040suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal00suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal00003987805787390department? or agency.00department? or agency.000022733059207402.?? Where the prospective lower tier participant is unable to certify to any of the statements in this certification, such prospective participants shall002.?? Where the prospective lower tier participant is unable to certify to any of the statements in this certification, such prospective participants shall00003987806054090attach an explanation to the loan application.00attach an explanation to the loan application.00001701807216140OTHER AGREEMENTS AND CERTIFICATIONS00OTHER AGREEMENTS AND CERTIFICATIONS00002273307454265I? authorize disclosure of all information submitted in connection with this application to the financial institution agreeing to participate with SBA's00I? authorize disclosure of all information submitted in connection with this application to the financial institution agreeing to participate with SBA's00002273307578090guaranteed debenture.? I waive all claims against SBA and its consultants for any management and technical assistance that may be provided.00guaranteed debenture.? I waive all claims against SBA and its consultants for any management and technical assistance that may be provided.00002273307701915In consideration for assistance from the Small Business Administration, I hereby agree that I will comply with all Federal laws and regulations to the 00In consideration for assistance from the Small Business Administration, I hereby agree that I will comply with all Federal laws and regulations to the 00002273307825740extent that they are applicable to such assistance, including conditions set forth in this application.? I, my spouse, or any other member of my 00extent that they are applicable to such assistance, including conditions set forth in this application.? I, my spouse, or any other member of my 00002273307949565household, or anyone who owns, manages, or directs the business or their spouses or members of their households do not work for the SBA,00household, or anyone who owns, manages, or directs the business or their spouses or members of their households do not work for the SBA,00002273308073390Small Business Advisory Council, SCORE or ACE, any Federal agency, or the participating lender.? If someone does, the name and address of 00Small Business Advisory Council, SCORE or ACE, any Federal agency, or the participating lender.? If someone does, the name and address of 00002273308197215such person and where employed is provided on an attached page.00such person and where employed is provided on an attached page.00002273306416040CONFLICTS OF INTEREST00CONFLICTS OF INTEREST00002273306625590No overlapping relationship exists between the small business concern, including its associates, and the CDC, including its associates, if any other00No overlapping relationship exists between the small business concern, including its associates, and the CDC, including its associates, if any other00002273306758940lender providing financing for the project that could create an appearance of a conflict of interest as defined in 13 CFR 120.140 or violate 13 CFR00lender providing financing for the project that could create an appearance of a conflict of interest as defined in 13 CFR 120.140 or violate 13 CFR00002273306892290120.851. No such relationships existed within six months of this application or will be permitted to exist while the assistance is outstanding.00120.851. No such relationships existed within six months of this application or will be permitted to exist while the assistance is outstanding.000036182308663940-10-00-10-000027305342900000002368553253740up a material fact by any trick, scheme or device, or makes any false, fictitious or fraudulent statements or representations, or makes or uses any00up a material fact by any trick, scheme or device, or makes any false, fictitious or fraudulent statements or representations, or makes or uses any00002273301529715files.? My signature represents my agreement to comply with the requirements SBA makes in connection with the approval of? my loan request00files.? My signature represents my agreement to comply with the requirements SBA makes in connection with the approval of? my loan request0000227330148590Applicant Notifications00Applicant Notifications0000227330358140I or any of the officers of my company ________? have/? ________? have not been involved in bankruptcy or insolvency proceedings. If so, I have00I or any of the officers of my company ________? have/? ________? have not been involved in bankruptcy or insolvency proceedings. If so, I have0000227330491490attached copies of the proceedings.00attached copies of the proceedings.0000227330739140I or my business _______? is/ ________? is not involved in any pending lawsuits. If so, I have attached a description.00I or my business _______? is/ ________? is not involved in any pending lawsuits. If so, I have attached a description.00002273301177290Applicant's Acknowledgement00Applicant's Acknowledgement00002273301386840My signature acknowledges receipt of these Statements Required by Laws and Executive Orders, that I have read it and that I have a copy for my00My signature acknowledges receipt of these Statements Required by Laws and Executive Orders, that I have read it and that I have a copy for my00002273303796665(Each Proprietor, each General Partner, each Limited Partner or Stockholder owning 20% or more, and each Guarantor must sign. Each person00(Each Proprietor, each General Partner, each Limited Partner or Stockholder owning 20% or more, and each Guarantor must sign. Each person00002273303930015should only sign once.)00should only sign once.)00002368554530090If Applicant is a proprietor or partnership, sign below:00If Applicant is a proprietor or partnership, sign below:000036658554530090If Applicant is an L.L.C. or corporation, sign below:00If Applicant is an L.L.C. or corporation, sign below:246380505396400367538050539640000002273305063490Name of Business00Name of Business000036849055053965Corporate Name00Corporate Name00002463805520690By:00By:379730562546400000021513805520690Date00Date2399030562546400000036753805520690By:00By:3808730562546400000055041805520690Date00Date5751830562546400000036753806006465Attested by:00Attested by:4265930611123900000060756806006465(seal if required)00(seal if required)00002654306196965Additional Proprietors, Partners, Stockholders or Guarantors as required.00Additional Proprietors, Partners, Stockholders or Guarantors as required.22733066446390022733070732640022733075304640022733080067140000002368556654165Signature00Signature00002368557073265Signature00Signature00002273307530465Signature00Signature00002368558016240Signature00Signature3656330664463900365633070732640036563307530464003656330800671400000036753806644640Date00Date000036658557073265Date00Date000036563307530465Date00Date000036468058016240Date00Date00002273308625840SBA Form 1244 (2-13) Previous Edition is Obsolete00SBA Form 1244 (2-13) Previous Edition is Obsolete00002559054749165?00?0000379730566356500000023799805454015000000303720532956500000017989557105650000007321556673215000000722630711136500000072263075685650000007131058035290000000366585564636650000003656330690181500000036563307359015000000365633078257400000002273302101215Certification as to Application Accuracy - Criminal Penalties for False Statements.00Certification as to Application Accuracy - Criminal Penalties for False Statements.00002273302310765All information in this application, including exhibits, is true and complete to the best of my knowledge and is submitted to SBA so that SBA can00All information in this application, including exhibits, is true and complete to the best of my knowledge and is submitted to SBA so that SBA can00002273302444115decide whether to approve this application.? Whoever makes any statement knowing it to be false, or whoever willfully overvalues any00decide whether to approve this application.? Whoever makes any statement knowing it to be false, or whoever willfully overvalues any00002273302577465security, for the purpose of obtaining any loan, or substitution of security therefore, or for the purpose of influencing in any way the action of 00security, for the purpose of obtaining any loan, or substitution of security therefore, or for the purpose of influencing in any way the action of 00002273302710815SBA, or for the purpose of obtaining money, property, or anything of value, under the Small Business Investment Act, as amended, may be00SBA, or for the purpose of obtaining money, property, or anything of value, under the Small Business Investment Act, as amended, may be00002273302844165punished by a fine of not more than $5,000 or by imprisonment for not more than two years, or both, pursuant to the Federal Law at 15 U.S.C. 645.00punished by a fine of not more than $5,000 or by imprisonment for not more than two years, or both, pursuant to the Federal Law at 15 U.S.C. 645.00002368553120390Whoever in any matter within the jurisdiction of any department or agency of the United States knowingly and willfully falsifies, conceals or covers00Whoever in any matter within the jurisdiction of any department or agency of the United States knowingly and willfully falsifies, conceals or covers00002368553387090false writing or documents knowing the same to contain any false, fictitious or fraudulent statement or entry may be fined up to $250,000 or00false writing or documents knowing the same to contain any false, fictitious or fraudulent statement or entry may be fined up to $250,000 or00002368553520440imprisoned for up to 5 years, or both, pursuant to the Federal Law at 18 U.S.C. 1001 and 3571.00imprisoned for up to 5 years, or both, pursuant to the Federal Law at 18 U.S.C. 1001 and 3571.0000504698026536650000002273301672590and to comply, whenever applicable, with the limitations contained in these Statements.00and to comply, whenever applicable, with the limitations contained in these Statements.000036182308625840-11-00-11-0000273053429000 ................
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