APPENDIX A 



Font NO. 3-I8B4 

 (NtNnaFn I35B) 



UNITED STATES 

 DEPARTMENT OF THE INTERIOR 



Budget Bohehu Ho. 42 -R 1295.2 

 Form Apnioveo 



APPLICATION FOR LOAN 



Pursuant to Section 4, Fish and WildliJc Act of 1956, Appiovcd August 8, 1956(70 Slot 1119) 



Date of ApplicatiOD: 



1. Full Dame and address of applicant (Print) 

 (Street, City, Zone, and State) 



Amount of loan requested: 



Maturity (period of loan) requested: 



2. Type of buslnes (attach brief histDxy of business on separate sheet): Dote business cstabli^ed: 



3. Purpose of loan (Give brief but clear general statement of need anid purpose of loan — Sec InftiucCLODS and use separate sheet.) 



4. 



NATURE OF EXPENDITURES TO BE MADE 



AMOUNT 



Total (Tills should agree with amount of loan requested) 



"S. Have you requested a loan from the Government dtulng the past 5 years? 



(Ye 



(No) 



If yes, explain: 



6. Recent efforts to obtain credit. 



The Department of the Interior Is authorized, as p r es cribed by the Fish and Wildlife Act of 15^6, to make loans to qualified membea 

 of the flibdng industry -only when the financial assistance Is not otherHrise available on reasonable tenns. Applicant must furnish evi- 

 dence that efforts were made within 90 days preceding the filing of this ^rpLication to obtain credit fiom banks or other sources. 

 Letteis declining to extend credit must be obtained fiom the bank, banks or instltutlDns in vrhich the applicant has a bank account, or 

 accounts. It is essential that these letters contain (1) date of ^>plication; (2) amount of loan and terms requested; and that they be at- 

 tached to this application • 



7 . Give two credit references: 



(A)_ 



(Name) 



(B) ,^ 



(Name) 

 Collateral offered by applicant as security for loan: 



(Address) 



(Addrea) 



Appraised by: 



Name _ 



^Describe existing Uens, if any, on poopexty listed above. 



T itle D ate 



Attach photograph of piopeity If avallableT 



9. Give names and experience of key personnel, with length of service or similar Infonnatlon, who manage and operate vevel or gear 

 for wrtiich the loan is proposed. (Use separate dieet) 



1(X Is vesel or gear now In operation? If not, explain why: 



