Loan 5B Enter the amount of loan funds for the second loan requested. Amount Requested 6 Enter a description of the operation. Description of Operation PART E Notifications, Certification and Acknowledgement – Items 1 18B are completed by all applicants. – Fld Name / Instruction Item No. 1 Check if you or any member of the entity ever conducted “YES” Business business under any other name, otherwise check If “NO”. “YES” Under Other provide names used in Item 9. Name 2 Check if you or any member of the entity ever obtained a direct “YES” Previous or guaranteed farm loan from FSA or the Farmers Home FSA or Administration; if not check “NO”. FmHA Loans 3 If Item 2 is if the government ever forgave any “YES”, check “YES” Debt debt through a write-down, write-off, compromise, adjustment, Forgiveness reduction, charge-off, paying a loss on a guarantee, or bankruptcy. If provide details in Item 9; otherwise check “YES”, “NO”. 4 Check if you or any member of the entity is delinquent on any “YES” Delinquent federal debt is not limited to education (i.e. “Federal Debt” includes but on Federal loans, delinquent taxes, obligations at Natural Resources Conservation Debt Service, obligations to FCIC, etc.) If provide details in Item 9, “YES,” otherwise check "NO". 5 Check if you or any member of the entity or the entity itself is “YES” Pending involved in any pending litigation. If provide details in Item 9, “YES,” Litigation otherwise check “NO”. 6 Check if you or any member of the entity has ever been in “YES” Bankruptcy receivership, been discharged, or filed a petition for reorganization in bankruptcy. If provide details in Item 9, otherwise check “YES,” “NO”. 7 Check if you are an employee, related to an employee, or closely “YES” Employee associated with an employee of the Farm Service Agency. If not, check
Loan 5B Amount Requested Enter the amount of loan funds for the second loan requested. 6 Description of Operation Enter a description of the operation. PART E – Notifications, Certification and Acknowledgement Items 1 – 18B are completed by all applicants. Fld Name / Item No. Instruction 1 Business Under Other Name Check “YES” if you or any member of the entity ever conducted business under any other name, otherwise check “NO”. If “YES” provide names used in Item 9. 2 Previous FSA or FmHA Loans Check “YES” if you or any member of the entity ever obtained a direct or guaranteed farm loan from FSA or the Farmers Home Administration; if not check “NO”. 3 Debt Forgiveness If Item 2 is “YES”, check “YES” if the government ever forgave any debt through a write-down, write-off, compromise, adjustment, reduction, charge-off, paying a loss on a guarantee, or bankruptcy. If “YES”, provide details in Item 9; otherwise check “NO”. 4 Delinquent on Federal Debt Check “YES” if you or any member of the entity is delinquent on any federal debt (i.e. “Federal Debt” includes but is not limited to education loans, delinquent taxes, obligations at Natural Resources Conservation Service, obligations to FCIC, etc.) If “YES,” provide details in Item 9, otherwise check "NO". 5 Pending Litigation Check “YES” if you or any member of the entity or the entity itself is involved in any pending litigation. If “YES,” provide details in Item 9, otherwise check “NO”. 6 Bankruptcy Check “YES” if you or any member of the entity has ever been in receivership, been discharged, or filed a petition for reorganization in bankruptcy. If “YES,” provide details in Item 9, otherwise check “NO”. 7 Employee Check “YES” if you are an employee, related to an employee, or closely associated with an employee of the Farm Service Agency. If not, check
FSA_2001_Instructions_Loan_Application_Form.docx