17. Names of Any Department of the Interior or SBA* Employees and/or Advisory Board Members who have any rela- 

 tionship or direct or indirect financial interest whatsoever in applicant (such interest to include any direct or indirect 

 financial interest in any other business entity or enterprise which is, in any way, connected with applicant) : 



NAME and address 



interest IN APPLICANT 



18. Agreement on Nonemployment of Department of the Interior or SBA Personnel. In consideration of the making by 



the Department of the Interior to applicant of all or any part of the loan applied for in this application, applicant hereby 

 agrees with the Department of the Interior that applicant will not, for a period of two years after disbursement by the 

 Department of the Interior to applicant of said loan, or any part thereof, employ or tender any office or employment to 

 or retain for professional sei-vices, any person who, on the date of such disbursement, or within one year prior to said 

 date, (a) shall have served as an officer, attorney, agent, or employee of Department of the Interior or SBA and (6) as 

 such, shall have occupied a position or engaged in activities which Department of the Interior or SBA shall have deter- 

 mined, or may determine, involve discretion with respect to the granting of assistance under the Fish and Wildlife Act 

 of 1956 or the Small Business Act of 1953, or said acts as they may be amended from time to time. 



19. Certification. I hereby certify that: 



(a) The applicant has not paid or incurred any obligation to pay, directly or indirectly, any fee or other compensation for 



obtaining the loan hereby applied for, and has not paid or will not make any payment for services in connection with this 

 application, without the consent of the Department of the Interior. 



(b) All information contained above and in exhibits attached hereto are true and complete to the best knowledge and belief 



of the applicant and are submitted for the purpose of inducing the Department of the Interior to grant a loan, or to 

 participate in a loan by a bank or other lending institution, to applicant. Whether or not the loan herein applied for 

 is approved, applicant agrees to pay or reimburse the Department of the Interior for the cost of any su!-\'eys, title 

 or mortgage examination, appraisals, etc., performed by non-Department of the Interior personnel with consent of 

 applicant. 



(Individual, general partner, trade name, or corporation) 



[seal] 



By 



Attest . 



Title 



Whoever makes any statement knowing it to be false, or whoever willfully ovei'values any security, for the purpose of obtain- 

 ing for himself or for any applicant any loan, or extension thereof by renewal, deferment of action, or otherwise, or the acceptance, 

 release, or substitution of security therefor, or for the purpose of influencing in any way the action of the Department of the 

 Interior, or for the purpose of obtaining money, property, or anything of value, under the Fish and Wildlife Act of 1956 shall 

 be punished as prescribed by law. 



'Small Business Administration. 



. S. eOVCRNMENT PHI, 



GPO 90557 2 



