APPENDIX NO. 5 



No. 3-llMSl 



UNITED STATES 

 DEPARTMENT OF THE INTERIOR 



Budget Bureau No. 42-R128S. 

 Approval expires June 30, 19&7. 



APPLICATION FOR LOAN 



Pursuant to Section 4, Fish and Wildlife Act of 1956, Approved Ausust 8, 1956(70 Stat. 1119) 



1. Full name and address of applicant (f rinf) 

 (Street, City, Zone, and State) 



Date of application : 



Amount of loan requested. 



Maturity (period of loan) requested: 



2. Type of business (Attach brief history of business on separate sheet) : 



Date business established : 



3. Purpose of loan {Give brief but clear general statement of need and purpose of loan — see Instructions and use separate sheet.) 



NATURE OF EXPENDITURE 



Total {This should agree tvith amount of loan requested) $ 



6. Have you requested a loan from the Government during the past 5 years? 



(Se.) 



(No) 



If yes, explain: 



6. Recent cfTorts to obtain credit. 



The Department of Interior is authorized, as prescribed by the Fish and Wildlife Act of 1956, to make loans to qualified 

 members of the fishing industry only when the financial assistance is not otherwise available on reasonable terms. Applicant 

 must furnish evidence that efTorts were made within 90 days preceding the filing of this application to obtain credit from 

 banks or other sources. Letters declining to extend credit must be obtained from the bank, banks, or in.stitutions in which the 

 applicant has a bank account, or accounts. It is essential that these letters contain (1) date of application; (2) amount of 

 loan requested; and tliat they be attached to this application. 



7. Give two credit references : 





(Name) 



(Address) 



