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ISA-FrrriliA <br />- ttvn FmHA 440.1 <br />isv. 9-10-76) <br />REQUEST1. FOR_111OBLIGATION OF FUNDS,, <br />ova 42 PAGE 740 . <br />FINANCE OFFICE ONLY <br />mLoan Number MFiscal Year <br />PA HT I --COMPLETE FOR ALL LOANS AND GRANTS: - <br />1. DATE OF APPROVAL .-.ST,_ COIB0RR0WER4bENTIFICATI0N <br />10 6 O9 <br />d 3. 0ot9I2®4477 <br />NO. NA1%4E FIELDS 1, 1,2, or 3 from below) <br />BORROWER'S NAME <br />1 <br />2 <br />3 <br />TYPE ACTION 1 - Obligation Only - <br />7 TYPE OF ASSISTANCE 8. TYPE OF LOAN FUNDS <br />{ (See FMI) 1 -Guaranteed <br />? RE'PAYMENT TERMS 11. DIRECT PAYMENT TO: <br />_T.I <br />STATE NAME <br />4.° ib4r <br />COUNTY NAME <br />5. Li—ndian River <br />2 - Oblig. & Check Request 3 - Correction of Oblig. <br />9. TYPE OF SUBMISSION <br />2 -Insured 1 -Initial 2-Subse --- <br />Tears 1-Cty Off 2 -Fin Off <br />=C9i4 OFFICIAL USE ONLY <br />14. Complete for Individuals Only <br />'—f 1-W]2-N/B 3 -AI 4 -SA 5-O <br />16. SEX OF BORR0WER(S) (Individuals Only): I 11-M <br />IT 8ORROWER(S) MARITAL STATUS (Individuals Only): <br />r� <br />q <br />12. CREDIT REPORT 13. VETERAN <br />3 -No 1 -Yes 2 -No 1 -Yes 2 -No <br />OR 15. TYPE OF ENTITY CODE(Association, Organizations, <br />etc. only) <br />6 -Tax Exempt 7 -Non -Tax Exempt 8-N/, <br />2-F <br />1 -Married 2 -Separated 3 -Unmarried (including widowed or divorced) <br />,. COMPLETE IF APPLICABLE (See FM!) 19. INTEREST RATE <br />MT__1 Credit Sale 2 -Assumption <br />'.0. PAYMENTS: I 11 -Monthly 2 -Annually 3 -Semiannually <br />4 -Gu: n.•,iy <br />A. AMOUNT OF LOAN 22. AMOUNT OF GRANT 23.AM0UNT OF IMMEDIATE ADVANCE <br />_E�Ti <br />! <br />t <br />1701 <br />" I.. [p] <br />IT10 <br />_AWI <br />I <br />'AAT II — EINI LOANS ONLY 24. DISASTER CODE <br />'AFT III -- ?MULTIPLE HOUSING ONLY <br />:T IMdTEfirSTCREDIT <br />26. PROFIT TYPE <br />1•Yes 72 No <br />1 -Full Profit 2 -Limited Profit 3 -Non -Profit <br />1Yi'E OF APPLICANT: <br />1 -Individual 2 -Partnership 3 -Corporation t,,j.e a"' <br />4 -Public Body <br />5 -Assn. of Farmers 6 -Or an. of FarrriWfters'.' - 7 -Other <br />INMVIDUAL HOUSING LOANS <br />1`'FE OF UNIT: 1 -Farm Tract 2 -Non -Farm Tract 29. ADJUSTED FAMILY INCOME <br />0 <br />1 -Build 2 -Purchase -New 3 -Purchase -Old 4 -Refinance <br />, <br />5 -Repair <br />•: 1_r:; I: ST CREDIT 32 TAXES AND INSURANCE <br />-7 <br />yurance y <br />1 -Yes 17 2 -No !•- Taxes 1st. rRIF <br />Taxes <br />. <br />2nd yr. <br />";OPAMUNITY SIZE -11 <br />34. FEE INSPECTION 35. SQUARE FOOTAGE OF <br />(M 0- less 2 -over 10.000 1 -Yes 2 -No LIVING AREA <br />"ADDITI0NAL <br />y E 1 V — INFOR(See FMI) <br />Position 2 FmHA 440-1 (Rev. 9-10-76) <br />