Declaration of Sarah Kerman (PX 3) — FTC v. Ponte Investments

Record facts

U.S. District Court, District of Rhode Island · No. 1:20-cv-00177-JJM-PAS · Doc. 5-4 · 2020-04-17 · Docket on CourtListener

Full text

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DECLARATION OF SARAH KERMAN
PURSUANT TO 28 U.S.C. § 1746
I, Sarah Kerman, hereby state that I have personal knowledge of the facts as set forth below and
am competent to testify about them.
1.

I am over 18 years old. I am a resident of Washington, D.C.

2.

I have worked as a Paralegal Specialist in the Division of Financial Practices at the
Federal Trade Commission since June 2018. I have been assigned to the SBA Loan
Program matter.

3.

My business address is 600 Pennsylvania Avenue, N.W., MailStop CC-10232,
Washington, D.C. 20580.

4.

As a Paralegal my responsibilities include investigating potential violations of consumer
protection laws. As a part of my job, I regularly review consumer complaints and contact
consumers to discuss information they have detailed in their written complaints.

5.

On April 14, 2020, I was asked to contact Bob Lockwood, the owner of Hewitt Cabinets
to find out more information about his interaction with SBA Loan Program. I called Bob
that same day.

6.

On our call, Bob told me that his business provides custom cabinets and employs eight
people. He mentioned that his business volume had recently dropped due to COVID-19,
and he was seeking financing to support the business during the pandemic.

7.

He told me that he was first contacted by SBA Loan Program over the phone on or around
March 30, 2020. Bob said that on the initial phone call a representative called his
business phone number and asked for him by name. Once Bob answered, the
representative asked if he was applying for a PPP loan.


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8.

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Bob told me that on the initial call with SBA Loan Program, the representative told him
that the government was passing the CARES Act and that SBA Loan Program was
helping businesses apply for PPP loans. Bob said the caller told him SBA Loan Program
would assist his business in applying for a loan and securing SBA funding.

9.

Bob said the SBA Loan Program rep asked for a lot of information about his business.
Bob told me he shared information about his company’s sales, the type of company, the
Tax ID number, and how long they’d been in business. He shared that he was searching
for additional financing since his cabinet business has seen business drop off as stay-inplace orders went into effect. Bob mentioned that the reason he shared this information
about his business was because he believed the SBA Loan Program was affiliated with the
SBA.

10.

After the initial call, Bob asked for more information. The representative from the SBA
Loan Program subsequently sent Bob three emails. True and correct copies of these
emails are attached to this declaration as Attachments A, B, and C.

11.

Attachment A is dated March 30, 2020. It was sent to Bob from
bodonnell@sbaloanprogram.com.

12.

The text of Attachment A includes the following: “While the final details are being
worked out with the government regarding the CARE Act we are providing assistance
with the SBA 7(a) Express loans, which affords businesses access immediately to loan
amounts up to 500,000 over a 10 year term (no prepayments) at a current interest rate of
6%, with monthly payments.”

13.

The email goes on to say: “We are the SBALoanProgram.com and as mandated by the
SBA, getting approved is easier than ever!” and “During the processing of your loan, once


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the CARE act is worked out, we will be participating in obtaining you funding for this as
well.”
14.

In Attachment A, Bill O’Donnell’s address is listed as 5700 Post Road
East Greenwich, RI 02818. His phone number is listed as (855) 746-0002 and his email
signature features a link to www.SBALoanProgram.com.

15.

After receiving the email in attachment A, Bob told me he tried to call the number listed
in Bill O’Donnell’s email signature to get information about the status of the SBA loan
application.

16.

Bob told me that when he tried calling, the phone kept ringing but no one answered. Bob
described being confused why no one answered the phone and there was no voicemail set
up. Bob replied to the initial email and asked why no one answered the phone.

17.

After my call with Bob on April 14, he forwarded me a third email he received from the
Small Business Loan Program. A true and correct copy of that email is attached to this
declaration as Attachment C.

18.

That email, dated April 1, 2020, was sent to Bob by Kayla Baldinelli,
kbaldinelli@sbaloanprogram.com with the subject line “SBA Loan Package.”
[Attachment C].

19.

At the top of that email is the SBA Loan Program logo. Below that logo a message
highlighted in yellow reads “Please note- We are participating in the Payment Protection
Program also. We will be reviewing your business for both loans, once documentation is
received we will let you know what you qualify for.”

20.

The email also says “Congratulations! Both you and your business have been preapproved for a SBA 7a Express Loan.”

21.

The email contains seven attachments, true and correct copies of which are appended to
this declaration as Attachments D-J. One of the attachments is titled “SBA Doc


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List.pdf.” Another attachment is titled “Borrower Paycheck Protection Program
Application (v1).pdf”
22.

The attachment titled “SBA Doc List” asks businesses to provide personal tax returns
dating back to 2016, balance sheets, and year-end payroll statements, among other documents.
[Attachment J].

23.

The attachment titled “Borrower Paycheck Protection Program Application (v1).pdf” asks
for the business’ TIN. The form also features the SBA logo in the upper left corner.
[Attachment F].

24.

On April 16, 2020, I reviewed a screen capture of a list of BBB complaints about the
company Ponte Investments LLC. The complaints mention that the company in some
instances withdrew funds without consumers’ authorization. The BBB complaints also
mention difficulty in reaching the company when consumers tried to inquire about the
status of their loan application.

I declare under penalty of perjury that the statements made in this declaration are true and
correct.

4/17/20
Executed in Washington, D.C. on _____________________.

_________________________
Sarah Michelle Kerman


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ATTACHMENT A


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From:
To:
Subject:
Date:

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Robert Lockwood
Kerman, Sarah
Fwd: Welcome to the SBA Loan Program
Tuesday, April 14, 2020 4:43:57 PM

Below is the first email I recieved
Best Bob
---------- Forwarded message --------From: <bodonnell@sbaloanprogram.com>
Date: Mon, Mar 30, 2020 at 2:00 PM
Subject: Welcome to the SBA Loan Program
To:
As discussed with Katie Ikes, from my office, concerning the current SBA programs
availableWhile the final details are being worked out with the government regarding the CARE Act
we are providing assistance with the SBA 7(a) Express loans, which affords businesses
access immediately to loan amounts up to 500,000 over a 10 year term (no prepayments)
at a current interest rate of 6%, with monthly payments.
We are the SBALoanProgram.com and as mandated by the SBA, getting approved is easier than

ever!
During the processing of your loan, once the CARE act is worked out, we will be
participating in obtaining you funding for this as well. Your loan processor will assist
you in the amount you will qualify for and details of this program based on your
financials provided to us.
We look forward to working with you in obtaining your new SBA loan.
Feel free to call or email me with any questions. 855-746-0002, ext. 101

Bill O'Donnell
5700 Post Road
East Greenwich, RI 02818
(855) 746-0002 | (302) 250-4649 Fax
SBALoanProgram.com
a division of Ponte Investments
Best Regards,
Bill ODonnell
Senior Loan Specialist
SBALoanProgram.com
(855) 746-0002 | (302) 250-4649 Fax


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-Hewitt Cabinets
T
F
www.HewittCabinets.com

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ATTACHMENT B


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Subject:
Date:
Attachments:

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Robert Lockwood
Kerman, Sarah
Fwd: Welcome to the SBA Loan Program
Tuesday, April 14, 2020 4:44:48 PM
Outlook-1510673397.jpg

2nd email when I asked why the phones were not being answered
---------- Forwarded message --------From: Bill Odonnell <bodonnell@sbaloanprogram.com>
Date: Tue, Mar 31, 2020 at 8:16 AM
Subject: Re: Welcome to the SBA Loan Program
To: Robert Lockwood

Hi Bob,
Katie has been on the phone - what is the best number for her to call you back at?
Best Regards,
Bill O'Donnell
Senior Loan Specialist
SBALoanProgram.com
1300 Division Road
Suite 305
West Warwick, RI 02893
(855) 746-0002 |
direct
www.sbaloanprogram.com
a division of Ponte Investments
Like us on Facebook at www.facebook.com/SBALoanProgram
Follow us on Twitter @SBALoanProgram

From: Robert Lockwood
Sent: Tuesday, March 31, 2020 11:14 AM
To: Bill Odonnell <bodonnell@sbaloanprogram.com>
Subject: Re: Welcome to the SBA Loan Program

Tried to call this morning but there is no answer. Is there another number?
Bob
On Mon, Mar 30, 2020 at 2:00 PM <bodonnell@sbaloanprogram.com> wrote:
As discussed with Katie Ikes, from my office, concerning the current SBA programs
availableWhile the final details are being worked out with the government regarding the CARE Act
we are providing assistance with the SBA 7(a) Express loans, which affords businesses
access immediately to loan amounts up to 500,000 over a 10 year term (no prepayments)
at a current interest rate of 6%, with monthly payments.
We are the SBALoanProgram.com and as mandated by the SBA, getting approved is easier than


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ever!
During the processing of your loan, once the CARE act is worked out, we will be
participating in obtaining you funding for this as well. Your loan processor will
assist you in the amount you will qualify for and details of this program based on
your financials provided to us.
We look forward to working with you in obtaining your new SBA loan.
Feel free to call or email me with any questions. 855-746-0002, ext. 101

Bill O'Donnell
5700 Post Road
East Greenwich, RI 02818
(855) 746-0002 | (302) 250-4649 Fax
SBALoanProgram.com
a division of Ponte Investments
Best Regards,
Bill ODonnell
Senior Loan Specialist
SBALoanProgram.com
(855) 746-0002 | (302) 250-4649 Fax

-Hewitt Cabinets
T
F
www.HewittCabinets.com

-Hewitt Cabinets
T
F
www.HewittCabinets.com


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ATTACHMENT C


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Subject:
Date:
Attachments:

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Robert Lockwood
Kerman, Sarah
Fwd: SBA Loan Package
Tuesday, April 14, 2020 4:46:26 PM
image002.png
image004.png
image005.jpg
image007.png
SBA Doc List.pdf
413PFS.pdf
Auth Form.pdf
business_debt_schedule.pdf
f4506t--2019_3-2019.pdf
SBA 1919 Application.pdf
Borrower Paycheck Protection Program Application (v1).pdf

Here is the basic terms and documents
---------- Forwarded message --------From: Kayla Baldinelli <kbaldinelli@sbaloanprogram.com>
Date: Wed, Apr 1, 2020 at 10:34 AM
Subject: SBA Loan Package
To:
Cc: Paul Copp <pcopp@sbaloanprogram.com>

Signature

* Please note- We are participating in the Payment Protection Program also. We will be reviewing
your business for both loans, once documentation is received we will let you know what you
qualify for.

Date: 04/01/2020

Congratulations! Both you and your business have been pre-approved for a SBA 7a Express
Loan.
Loan Amounts up to: $5,000,000.00
Term: 10 Years, with no prepayment penalty
Adjustable Interest Rate: Prime 3.25% Plus a Margin of 2.75% Totaling- 6%
Use of Funds: Working Capital, Consolidation, Expansion, Marketing, New Hires, Etc.
Closing Fees: 2% of loan amount will be taken from loan proceeds at closing


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Collateral: Dependent upon loan amount.

Important Information: Please forward the requested items within 5 business days to my email
kbaldinelli@sbaloanprogram.com.
You may also feel free to use our FedEx Account number: 321386474 to overnight everything to
us.

Your assigned loan specialist will reach out to you for assistance, I am also available at any time
via email or phone to answer all questions and concerns you may have.

Respectfully,

Kayla Baldinelli
Vice President of Operations
Signature

1300 Division Rd Suite 305 West Warwick, RI 02893
Office: 401.398.8930 Direct:
Fax: 1.401.223.9690 Toll Free: 888-982-8380
www.sbaloanprogram.com

-Hewitt Cabinets
T
F
www.HewittCabinets.com


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ATTACHMENT D


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OMB APPROVAL NO.: 3245-0188
EXPIRATION DATE: 03/31/2021

PERSONAL FINANCIAL STATEMENT
7(a) / 504 LOANS AND SURETY BONDS
U.S. SMALL BUSINESS ADMINISTRATION

As of ________________, ________

SBA uses the information required by this Form 413 as one of a number of data sources in analyzing the repayment ability and creditworthiness of
an application for an SBA guaranteed 7(a) or 504 loan or, with respect to a surety bond, to assist in recovery in the event that the contractor
defaults on the contract. Submission of this information is required as part of your application for assistance. Failure to provide the information
would impact the agency’s decision on your application.
Complete this form for: (1) each proprietor; (2) general partner; (3) managing member of a limited liability company (LLC); (4) each owner of 20% or
more of the equity of the Applicant (including the assets of the owner’s spouse and any minor children); and (5) any person providing a guaranty on
the loan
Return completed form to:
For 7(a) loans: the Lender processing the application for SBA guaranty
For 504 loans: the Certified Development Company (CDC) processing the application for SBA guaranty
For Surety Bonds: the Surety Company or Agent processing the application for surety bond guarantee

Name

Business Phone

Home Address

Home Phone

City, State, & Zip Code
Business Name of Applicant
ASSETS

(Omit Cents)

LIABILITIES

(Omit Cents)

Cash on Hand & in banks…………………………$ ________________
Savings Accounts…………………………………..$ ________________
IRA or Other Retirement Account………………...$ ________________
(Describe in Section 5)
Accounts & Notes Receivable…………………….$ ________________
(Describe in Section 5)
Life Insurance – Cash Surrender Value Only……$ ________________
(Describe in Section 8)
Stocks and Bonds…………………………………..$ ________________
(Describe in Section 3)
Real Estate…………………………………………..$ ________________
(Describe in Section 4)
Automobiles…………………………………………$ ________________
(Describe in Section 5, and include
Year/Make/Model)
Other Personal Property……………………………$ ________________
(Describe in Section 5)
Other Assets………………………………………….$ _______________
(Describe in Section 5)
Total
$ ________________

Accounts Payable……………………………$ ______________
Notes Payable to Banks and Others……….$ ______________
(Describe in Section 2)
Installment Account (Auto)…………………..$ ______________
Mo. Payments
$ ___________
Installment Account (Other)………………....$ ______________
Mo. Payments
$ ___________
Loan(s) Against Life Insurance……………...$ ______________
Mortgages on Real Estate…………………...$ ______________
(Describe in Section 4)
Unpaid Taxes………………………………….$ _____________
(Describe in Section 6)
Other Liabilities………………………………..$ _____________
(Describe in Section 7)
Total Liabilities………………………………....$ _____________
Net Worth……………………………………….$ _____________

Section 1.

Contingent Liabilities

Source of Income.

Salary………………………………………………….$ ________________
Net Investment Income……………………………...$ ________________
Real Estate Income………………………………….$ ________________
Other Income (Describe below)*…………………...$ ________________

Total
$ _____________
*Must equal total in assets column.

As Endorser or Co-Maker…………………….$ _____________
Legal Claims & Judgments…………………..$ _____________
Provision for Federal Income Tax…………....$_____________
Other Special Debt…………………………….$ _____________

Description of Other Income in Section 1.

*Alimony or child support payments should not be disclosed in “Other Income” unless it is desired to have such payments counted toward total income.

SBA Form 413 (7a/504/SBG) (01-18) Previous Editions Obsolete

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Section 2.Case
Notes Payable to
Banks and Others. (Use attachments
if 5-4
necessary. Each
must be identified
partof
of this
and signed.)
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Names and Addresses of
Noteholder(s)

Original
Balance

Current
Balance

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Payment
Amount

Frequency
(monthly, etc.)

How Secured or Endorsed
Type of Collateral

Section 3. Stocks and Bonds. (Use attachments if necessary. Each attachment must be identified as part of this statement and signed.)
Number of Shares

Name of Securities

Cost

Market Value
Quotation/Exchange

Date of
Quotation/Exchange

Total Value

Section 4. Real Estate Owned. (List each parcel separately. Use attachment if necessary. Each attachment must be identified as a part of this statement
and signed.)

Property A

Property B

Property C

Type of Real Estate (e.g.
Primary Residence, Other
Residence, Rental Property,
Land, etc.)
Address
Date Purchased
Original Cost
Present Market Value
Name & Address of
Mortgage Holder
Mortgage Account Number
Mortgage Balance
Amount of Payment per
Month/Year
Status of Mortgage
Section 5. Other Personal Property and Other Assets. (Describe, and, if any is pledged as security, state name and address of lien
holder, amount of lien, terms of payment and, if delinquent, describe delinquency.)

Section 6. Unpaid Taxes. (Describe in detail as to type, to whom payable, when due, amount, and to what property, if any, a tax
lien attaches.)

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Section 7. Other Liabilities. (Describe in detail.)

Section 8. Life Insurance Held. (Give face amount and cash surrender value of policies – name of insurance company and
Beneficiaries.)

I authorize the SBA/Lender/Surety Company to make inquiries as necessary to verify the accuracy of the statements made and to
determine my creditworthiness.
CERTIFICATION: (to be completed by each person submitting the information requested on this form and the spouse of any 20% or
more owner when spousal assets are included)
By signing this form, I certify under penalty of criminal prosecution that all information on this form and any additional supporting
information submitted with this form is true and complete to the best of my knowledge. I understand that SBA or its participating
Lenders or Certified Development Companies or Surety Companies will rely on this information when making decisions regarding an
application for a loan or a surety bond. I further certify that I have read the attached statements required by law and executive order.
Signature ________________________________________

Date

____________________

Print Name _______________________________________

Social Security No.

____________________

Signature ________________________________________

Date

____________________

Print Name _______________________________________

Social Security No.

____________________

NOTICE TO LOAN AND SURETY BOND APPLICANTS: CRIMINAL PENALITIES AND ADMINISTRATIVE REMEDIES FOR
FALSE STATEMENTS:
Knowingly making a false statement on this form is a violation of Federal law and could result in criminal prosecution, significant civil
penalties, and a denial of your loan or surety bond application. A false statement is punishable under 18 U.S.C. §§ 1001 and 3571 by
imprisonment of not more than five years and/or a fine of up to $250,000; under 15 U.S.C. § 645 by imprisonment of not more than
two years and/or a fine of not more than $5,000; and, if submitted to a Federally-insured institution, a false statement is punishable
under 18 U.S.C. § 1014 by imprisonment of not more than thirty years and/or a fine of not more than $1,000,000. Additionally, false
statements can lead to treble damages and civil penalties under the False Claims Act, 31 U.S.C. § 3729, and other administrative
remedies including suspension and debarment.

PLEASE NOTE:

According to the Paperwork Reduction Act, you are not required to respond to this request for information unless it displays a valid OMB
Control Number. The estimated average burden hours for the completion of this form is 1.5 hours per response. If you have questions or
comments concerning this estimate or any other aspect of this information collection, please contact: Director, Records Management
Division, Small Business Administration, 409 Third Street SW, Washington, D.C. 20416, and SBA Desk Officer, Office of Management and
Budget, New Executive Office Building, Room 10202, Washington, D.C. 20503. PLEASE DO NOT SEND COMPLETED FORMS TO OMB.

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PLEASE READ, DETACH, AND#:RETAIN
FOR YOUR RECORDS
STATEMENTS REQUIRED BY LAW AND EXECUTIVE ORDER
SBA is required to withhold or limit financial assistance, to impose special conditions on approved loans, to provide
special notices to applicants or borrowers and to require special reports and data from borrowers in order to comply with
legislation passed by the Congress and Executive Orders issued by the President and by the provisions of various interagency agreements. SBA has issued regulations and procedures that implement these laws and executive orders. These are
contained in Parts 112, 113, and 117 of Title 13 of the Code of Federal Regulations and in Standard Operating
Procedures.
Privacy Act (5 U.S.C. 552a)
Any person can request to see or get copies of any personal information that SBA has in his or her file when that file is
retrieved by individual identifiers such as name or social security numbers. Requests for information about another party
may be denied unless SBA has the written permission of the individual to release the information to the requestor or
unless the information is subject to disclosure under the Freedom of Information Act.
Under the provisions of the Privacy Act, you are not required to provide your social security number. Failure to provide
your social security number may not affect any right, benefit or privilege to which you are entitled. Disclosures of name
and other personal identifiers are, however, required for a benefit, as SBA requires an individual seeking assistance from
SBA to provide it with sufficient information for it to make a character determination. In determining whether an
individual is of good character, SBA considers the person’s integrity, candor, and disposition toward criminal actions.
Additionally, SBA is specifically authorized to verify your criminal history, or lack thereof, pursuant to section
7(a)(1)(B), 15 USC Section 636(a)(1)(B) of the Small Business Act ( the Act). Further, for all forms of assistance, SBA is
authorized to make all investigations necessary to ensure that a person has not engaged in acts that violate or will violate
the Act or the Small Business Investment Act, 15 USC Sections 634(b)(11) and 687(b)(a), respectively. For these
purposes, you are asked to voluntarily provide your social security number to assist SBA in making a character
determination and to distinguish you from other individuals with the same or similar name or other personal identifier.
The Privacy Act authorizes SBA to make certain “routine uses” of information protected by that Act. One such routine
use is the disclosure of information maintained in SBA’s investigative files system of records when this information
indicates a violation or potential violation of law, whether civil, criminal, or administrative in nature. Specifically, SBA
may refer the information to the appropriate agency, whether Federal, State, local or foreign, charged with responsibility
for, or otherwise involved in investigation, prosecution, enforcement or prevention of such violations. Another routine use
is that SBA may disclose the information maintained in SBA’s investigative files to other Federal agencies conducting
background checks to the extent the information is relevant to the requesting agencies' function. In addition, another
routine use is that SBA may transfer information related to a debt that a person is delinquent in paying to SBA in
connection with its loan programs for publication on a computer database system maintained by the Department of
Housing and Urban Development, or other Federal agency, to allow searches by participating Government agencies and
approved private lenders, consistent with applicable law. SBA and its authorized lenders may also use this computer
database system to perform a computer match to determine a loan applicant’s credit status with participating agencies of
the Federal Government. See Revision of Privacy Act System of Records, 74 F.R. 14890 (April 1, 2009) and 77 F.R.
61467 (October 9, 2012) for additional background and other routine uses, which may be amended from time to time.
Right to Financial Privacy Act of 1978 (12 U.S.C. 3401) -- This is notice to you as required by the Right to Financial
Privacy Act of 1978, of SBA's access rights to financial records held by financial institutions that are or have been doing
business with you or your business, including any financial institutions participating in a loan or loan guaranty. The law
provides that SBA shall have a right of access to your financial records in connection with its consideration or
administration of assistance to you in the form of a Government guaranteed loan. SBA is required to provide a certificate
of its compliance with the Act to a financial institution in connection with its first request for access to your financial
records, after which no further certification is required for subsequent accesses. The law also provides that SBA's access
rights continue for the term of any approved loan guaranty agreement. No further notice to you of SBA's access rights is
required during the term of any such agreement. The law also authorizes SBA to transfer to another Government authority
any financial records included in an application for a loan, or concerning an approved loan or loan guarantee, as necessary
to process, service or foreclose on a loan guaranty or collect on a defaulted loan guaranty.
Freedom of Information Act (5 U.S.C. 552)
This law provides, with some exceptions, that SBA must supply information reflected in agency files and records to a
person requesting it. Information about approved loans that will be automatically released includes, among other things,
statistics on our loan programs (individual borrowers are not identified in the statistics) and other information such as the
names of the borrowers (and their officers, directors, stockholders or partners), the collateral pledged to secure the loan,
the amount of the loan, its purpose in general terms and the maturity. Proprietary data on a borrower would not routinely
be made available to third parties. All requests under this Act are to be addressed to the nearest SBA office and be
identified as a Freedom of Information request.

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Flood Disaster Protection Act (42 U.S.C. 4011) -- Regulations have been issued by the Federal Insurance
Administration (FIA) and by SBA implementing this Act and its amendments. These regulations prohibit SBA from
making certain loans in an FIA designated floodplain unless Federal Flood insurance is purchased as a condition of the
loan. Failure to maintain the required level of flood insurance makes the applicant ineligible for any financial assistance
from SBA, including disaster assistance.
Executive Orders -- Floodplain Management and Wetland Protection (42 F.R. 26951 and 42 F.R. 26961) – SBA
discourages settlement in or development of a floodplain or a wetland. This statement is to notify all SBA loan applicants
that such actions are hazardous to both life and property and should be avoided. The additional cost of flood preventive
construction must be considered in addition to the possible loss of all assets and investments due to a future flood.
Occupational Safety and Health Act (15 U.S.C. 651 et seq.) -- This legislation authorizes the Occupational Safety and
Health Administration in the Department of Labor to require businesses to modify facilities and procedures to protect
employees or pay penalty fees. Businesses can be forced to cease operations or be prevented from starting operations in a
new facility. Therefore, SBA may require additional information from an applicant to determine whether the business will
be in compliance with OSHA regulations and allowed to operate its facility after the loan is approved and disbursed.
Signing this form as an applicant is certification that the OSHA requirements that apply to the applicant business have
been determined and that the applicant, to the best of its knowledge, is in compliance. Furthermore, applicant certifies that
it will remain in compliance during the life of the loan.
Civil Rights Legislation -- All businesses receiving SBA financial assistance must agree not to discriminate in any
business practice, including employment practices and services to the public on the basis of categories cited in 13 C.F.R.,
Parts 112, 113, and 117 of SBA Regulations. This includes making their goods and services available to handicapped
clients or customers. All business borrowers will be required to display the "Equal Employment Opportunity Poster"
prescribed by SBA.
Equal Credit Opportunity Act (15 U.S.C. 1691) -- The Federal Equal Credit Opportunity Act prohibits creditors from
discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status or age
(provided the applicant has the capacity to enter into a binding contract); because all or part of the applicant's income
derives from any public assistance program, or because the applicant has in good faith exercised any right under the
Consumer Credit Protection Act.
Executive Order 11738 -- Environmental Protection (38 F.R. 251621) -- The Executive Order charges SBA with
administering its loan programs in a manner that will result in effective enforcement of the Clean Air Act, the Federal
Water Pollution Act and other environment protection legislation.
Debt Collection Act of 1982, Deficit Reduction Act of 1984 (31 U.S.C. 3701 et seq. and other titles) -- These laws
require SBA to collect aggressively any loan payments which become delinquent. SBA must obtain your taxpayer
identification number when you apply for a loan. If you receive a loan, and do not make payments as they come due, SBA
may take one or more of the following actions: (1) report the status of your loan(s) to credit bureaus, (2) hire a collection
agency to collect your loan, (3) offset your income tax refund or other amounts due to you from the Federal Government,
(4) suspend or debar you or your company from doing business with the Federal Government, (5) refer your loan to the
Department of Justice or other attorneys for litigation, (6) foreclose on collateral or take other action permitted in the loan
instruments, or (7) if you default on an SBA loan and fail to fully reimburse SBA for any resulting loss, refer you to the
computer database of delinquent Federal debtors maintained by the Department of Housing and Urban Development, or
other Federal agency, which may disqualify you from receiving financial assistance from other Federal agencies. In
addition, unless SBA is reimbursed in full for the loss, you will not be eligible for additional SBA financial assistance.
Immigration Reform and Control Act of 1986 (Pub. L. 99-603) -- If you are an alien who was in this country illegally
since before January 1, 1982, you may have been granted lawful temporary resident status by the United States
Immigration and Naturalization Service pursuant to the Immigration Reform and Control Act of 1986. For five years from
the date you are granted such status, you are not eligible for financial assistance from the SBA in the form of a loan
guaranty under Section 7(a) of the Small Business Act unless you are disabled or a Cuban or Haitian entrant. When you
sign this document, you are making the certification that the Immigration Reform and Control Act of 1986 does not apply
to you, or if it does apply, more than five years have elapsed since you have been granted lawful temporary resident status
pursuant to such 1986 legislation.
Lead-Based Paint Poisoning Prevention Act (42 U.S.C. 4821 et seq.) -- Borrowers using SBA funds for the
construction or rehabilitation of a residential structure are prohibited from using lead-based paint (as defined in SBA
regulations) on all interior surfaces, whether accessible or not, and exterior surfaces, such as stairs, decks, porches,
railings, windows and doors, which are readily accessible to children under 7 years of age. A "residential structure" is any
home, apartment, hotel, motel, orphanage, boarding school, dormitory, day care center, extended care facility, college or
other school housing, hospital, group practice or community facility and all other residential or institutional structures
where persons reside.

SBA Form 413 (7a/504/SBG) (01-18) Previous Editions Obsolete

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Page 22 of 44 PageID

Executive Order 12549, Debarment and Suspension (2 CFR 180, adopted by reference in 2 CFR Part 2700 (SBA
Debarment Regulations)) -- By submission of this loan application, you certify and acknowledge that neither you nor
any Principals have within the past three years been: (a) debarred, suspended, declared ineligible from participating in, or
voluntarily excluded from participation in a transaction by any Federal department or agency; (b) formally proposed for
debarment, with a final determination still pending; (c) indicted, convicted, or had a civil judgment rendered against you
for any of the offenses listed in the Regulations; or (d) delinquent on any amounts due and owing to the U.S. Government
or its agencies or instrumentalities as of the date of execution of this certification.
If you are unable to certify and acknowledge (a) through (d), you must obtain and attach a written statement of exception
from SBA permitting participation in this loan. You further certify that you have not and will not knowingly enter into
any agreement in connection with the goods and/or services purchased with the proceeds of this loan with any individual
or entity that has been debarred, suspended, declared ineligible from participating in, or voluntarily excluded from
participation in a Transaction. All capitalized terms have the meanings set forth in 2 C.F.R. Part 180.

SBA Form 413 (7a/504/SBG) (01-18) Previous Editions Obsolete

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ATTACHMENT E


Case 1:20-cv-00177-JJM-PAS

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#: 184

Filed 04/17/20

Page 24 of 44 PageID

Authorization To Obtain & Release Information
Business Name:
I/We authorize Ponte Investments LLC D/B/A www.sbaloanprogram.com and its funding
providers to gather, obtain, and verify required information for submission of a loan
application to a financial institution to obtain financing for my business as well as obtain
and verify any and all creditor payoffs.
I further authorize Ponte Investments LLC DBA www.sbaloanprogram.com to order a
consumer credit report and verify other credit information as needed in connection with
the above financing.
I/We understand that if the small business defaults on the SBA-guaranteed loan and SBA
suffers a loss, the names of the small business and the guarantors of the SBA
guaranteed loan will be referred for listing in the U.S CAIVRS database, which may affect
your eligibility for further financial assistance.
It is acknowledged that an executed copy of this form will also serve as proper
authorization and consent.

Signature:
Date:
Print Name:

Signature:
Date:
Print Name:


Case 1:20-cv-00177-JJM-PAS

Document 5-4
#: 185

Filed 04/17/20

Page 25 of 44 PageID

ATTACHMENT F


Case 1:20-cv-00177-JJM-PAS

Document 5-4 Filed 04/17/20
#: 186 Program
Paycheck Protection

Page 26 of 44 PageID
OMB Control No.: 3245-

Application Form

Expiration Date: 06/30/2020

Non-Profit տ Vet Org տ Tribal տ Ind. Cont.
‰Employed տ
(‰տ Self

DBA or Tradename if applicable

Business Legal Name
Business Primary Address

Business TIN (EIN,SSN)

Business Phone

(

)

Primary Contact

Average Monthly Payroll:

$

X 2.5 equals Loan Amount:

$

Email Address

Number of Jobs:

Purpose of the loan
(select more than one):

‫܆‬Payroll տRent / Mortgage Interest տUtilities տOther (explain):
Applicant Ownership

List all owners of Applicant with greater than 20% ownership stakes. Attach a separate sheet if necessary.
Owner Name

Title

Ownership %

TIN (EIN,SSN)

Address

If questions (1) or (2) below are answered “Yes,” the loan will not be approved.
Question

Yes

No

1.

Is the Business or any owner presently suspended, debarred, proposed for debarment, declared ineligible, voluntarily excluded  
from participation in this transaction by any Federal department or agency, or presently involved in any bankruptcy?
‫܆܆‬

2.

Has the Business, any of its owners, or any business owned or controlled by any of them, ever obtained a direct or guaranteed
loan from SBA or any other Federal agency that is currently delinquent or has defaulted in the last 7 years and caused a loss to
the government?

‫܆܆‬

3.

Is the Business or any owner an owner of any other business or have common management with any other business? If yes,
attach a listing of all Affiliates and describe the relationship as addendum A.

‫܆܆‬

4.

Has the Business received an SBA Economic Injury Disaster Loan between January 31, 2020 and April 3, 2020? If yes,
provide details on a separate sheet identified as addendum B.

‫܆܆‬

Applicants who are individuals and all 20% or greater owners of the business must answer the following questions. If
questions (5) or (6) are answered “Yes” or question (7) is answered “No”, the loan will not be approved.
Question
5.

Yes

Are you presently subject to an indictment, criminal information, arraignment, or other means by
which formal criminal charges are brought in any jurisdiction, or presently incarcerated, on probation
or parole?

No

‫܆ ܆‬

Initial here to confirm your response to question 5 ĺ
6.

Within the last 7 years, for any felony or misdemeanor for a crime against a minor, have you: 1) been
convicted; 2) pleaded guilty; 3) pleaded nolo contendere; 4) been placed on pretrial diversion; or 5) been
placed on any form of parole or probation (including probation before judgment)?
Initial here to confirm your response to question 6 ĺ

7.

‫ ܆‬I am a U.S. Citizen OR ‫ ܆‬I have Lawful Permanent Resident status

‫ ܆‬No

Initial here to confirm your response to question 7 ĺ

1
SBA Form 2483 (03/20)

‫܆ ܆‬


Case 1:20-cv-00177-JJM-PAS

Document 5-4 Filed 04/17/20
#: 187 Program
Paycheck Protection

Page 27 of 44 PageID

Application Form

OMB Control No.: 3245Expiration Date: 06/30/2020

By Signing Below, You Make the Following Representations, Authorizations, and Certifications
REPRESENTATIONS AND AUTHORIZATIONS
I represent that:
x I have read the Statements Required by Law and Executive Order included in this form, and I understand them.
x I will comply, whenever applicable, with the civil rights and other limitations in this form.
x All SBA loan proceeds will be used only for business related purposes as specified in the loan application.
x To the extent feasible, I will purchase only American-made equipment and products.
x The Applicant is not engaged in any activity that is illegal under federal, state or local law.
For Applicants who are individuals and all Associates: I authorize the SBA to request criminal record information about me from criminal justice
agencies for the purpose of determining my eligibility for programs authorized by the Small Business Act, as amended.
CERTIFICATIONS
The Business and each 20% or greater owner must certify in good faith to all of the below by initialing next to each one:
_____

Current economic uncertainty makes this loan request necessary to support the ongoing operations of the Applicant.

_____

The funds will be used to retain workers and maintain payroll or make mortgage payments, lease payments, and utility payments; I
understand that if the funds are used for unauthorized purposes, the federal government may pursue criminal fraud charges.

_____

Documentation verifying the number of full-time equivalent employees on payroll as well as the dollar amounts of payroll costs, covered
mortgage interest payments, covered rent payments, and covered utilities for the eight week period following this loan will be provided
to the lender.

_____

Loan forgiveness will be provided for the sum of documented payroll costs, covered mortgage interest payments, covered rent payments,
and covered utilities. Due to likely high subscription, it is anticipated that not more than twenty-five percent (25%) of the forgiven
amount may be for non-payroll costs.

_____

During the period beginning on February 15, 2020 and ending on December 31, 2020, the Applicant has not and will not receive another
loan under this program.

_____

I further certify that the information provided in this application and the information that I have provided in all supporting
documents and forms is true and accurate. I realize that knowingly making a false statement to obtain a guaranteed loan from SBA is
punishable under 18 USC 1001 and 3571 by imprisonment of not more than five years and/or a fine of up to $250,000; under 15 USC
645 by imprisonment of not more than two years and/or a fine of not more than $5,000; and, if submitted to a Federally insured
institution, under 18 USC 1014 by imprisonment of not more than thirty years and/or a fine of not more than $1,000,000.

_____

I acknowledge that the lender will calculate the eligible loan amount using tax documents I have submitted. I affirm that these
tax documents are identical to those I submitted to the IRS. I also understand, acknowledge and agree that the Lender can share
the tax information with SBA's authorized representatives, including authorized representatives of the SBA Office of Inspec tor
General, for the purpose of compliance with SBA Loan Program Requirements and all SBA reviews.

_________________________________________________________
Signature of Authorized Representative of Business

________________________
Date

Print Name

Title

________________________________________________________
Signature of Owner of Applicant Business

________________________
Date

Print Name

Title

2
SBA Form 2483 (03/20)


Case 1:20-cv-00177-JJM-PAS

Document 5-4 Filed 04/17/20
#: 188 Program
Paycheck Protection

Page 28 of 44 PageID

Application Form

OMB Control No.: 3245Expiration Date: 06/30/2020

Purpose of this form:
This form is to be completed by the Applicant and all individuals identified below and submitted to your SBA Participating Lender.
Submission of the requested information is required to make a determination regarding eligibility for financial assistance. Failure to submit the
information would affect that determination.
Instructions for completing this form:
For purposes of calculating “Average Monthly Payroll”, most Applicants will use the average monthly payroll for 2019, excluding costs over
$100,000 on an annualized basis for each employee. For seasonal businesses, the Applicant may elect to instead use average monthly payroll
for the time period between February 15, 2019 and June 30, 2019, excluding costs over $100,000 on an annualized basis for each employee.
For new businesses, average monthly payroll may be calculated using the time period from January 1, 2020 to February 29, 2020, excluding
costs over $100,000 on an annualized basis for each employee.
The first section and questions 1-4 request information about the Business. Questions 5-7 are to be completed, signed and dated by each
applicant who is an Individual as well as each 20% or greater owner of an Applicant Business. All parties listed below are considered owners of
the Applicant Business as defined in 13 CFR § 120.10, as well as “principals.”

x For a sole proprietorship, the sole proprietor;
x For a partnership, all general partners, and all limited partners owning 20% or more of the equity of the firm;
x For a corporation, all owners of 20% or more of the corporation;
x For limited liability companies, all members owning 20% or more of the company; and
x Any Trustor (if the Applicant is owned by a trust).
Paperwork Reduction Act – You are not required to respond to this collection of information unless it displays a currently valid OMB
Control Number. The estimated time for completing this application, including gathering data needed, is 8 minutes. Comments about this time
or the information requested should be sent to : Small Business Administration, Director, Records Management Division, 409 3rd St., SW,
Washington DC 20416., and/or SBA Desk Officer, Office of Management and Budget, New Executive Office Building, Washington DC
20503.
Privacy Act (5 U.S.C. 552a) – Under the provisions of the Privacy Act, you are not required to provide your social security number. Failure to
provide your social security number may not affect any right, benefit or privilege to which you are entitled. (But see Debt Collection Notice
regarding taxpayer identification number below). Disclosures of name and other personal identifiers are required to provide SBA with
sufficient information to make a character determination. When evaluating character, SBA considers the person’s integrity, candor, and
disposition toward criminal actions. Additionally, SBA is specifically authorized to verify your criminal history, or lack thereof, pursuant to
section 7(a)(1)(B), 15 USC Section 636(a)(1)(B) of the Small Business Act (the Act).
Disclosure of Information: Requests for information about another party may be denied unless SBA has the written permission of the
individual to release the information to the requestor or unless the information is subject to disclosure under the Freedom of Information Act.
The Privacy Act authorizes SBA to make certain “routine uses” of information protected by that Act. One such routine use is the disclosure of
information maintained in SBA’s system of records when this information indicates a violation or potential violation of law, whether civil,
criminal, or administrative in nature. Specifically, SBA may refer the information to the appropriate agency, whether Federal, State, local or
foreign, charged with responsibility for, or otherwise involved in investigation, prosecution, enforcement or prevention of such violations.
Another routine use is disclosure to other Federal agencies conducting background checks but only to the extent the information is relevant to
the requesting agencies' function. See, 74 F.R. 14890 (2009), and as amended from time to time for additional background and other routine
uses. In addition, the CARES Act, requires SBA to register every loan made under the Paycheck Protection Act using the Taxpayer
Identification Number (TIN) assigned to the borrower.
Debt Collection Act of 1982, Deficit Reduction Act of 1984 (31 U.S.C. 3701 et seq. and other titles) – SBA must obtain your taxpayer
identification number when you apply for a loan. If you receive a loan, and do not make payments as they come due, SBA may: (1) report the
status of your loan(s) to credit bureaus, (2) hire a collection agency to collect your loan, (3) offset your income tax refund or other amounts
due to you from the Federal Government, (4) suspend or debar you or your company from doing business with the Federal Government, (5)
refer your loan to the Department of Justice, or (6) foreclose on collateral or take other action permitted in the loan instruments.
Right to Financial Privacy Act of 1978 (12 U.S.C. 3401) – The Right to Financial Privacy Act of 1978, grants SBA access rights to
financial records held by financial institutions that are or have been doing business with you or your business including any financial
institutions participating in a loan or loan guaranty. SBA is only required provide a certificate of its compliance with the Act to a financial
institution in connection with its first request for access to your financial records. SBA's access rights continue for the term of any approved
loan guaranty agreement. SBA is also authorized to transfer to another Government authority any financial records concerning an approved
loan or loan guarantee, as necessary to process, service or foreclose on a loan guaranty or collect on a defaulted loan guaranty.

3
SBA Form 2483 (03/20)


Case 1:20-cv-00177-JJM-PAS

Document 5-4 Filed 04/17/20
#: 189 Program
Paycheck Protection
Application Form

Page 29 of 44 PageID
OMB Control No.: 3245Expiration Date: 06/30/2020

Freedom of Information Act (5 U.S.C. 552) – Subject to certain exceptions, SBA must supply information reflected in agency files and
records to a person requesting it. Information about approved loans that will be automatically released includes, among other things, statistics
on our loan programs (individual borrowers are not identified in the statistics) and other information such as the names of the borrowers (and
their officers, directors, stockholders or partners), the collateral pledged to secure the loan, the amount of the loan, its purpose in general terms
and the maturity. Proprietary data on a borrower would not routinely be made available to third parties. All requests under this Act are to be
addressed to the nearest SBA office and be identified as a Freedom of Information request.
Occupational Safety and Health Act (15 U.S.C. 651 et seq.) – The Occupational Safety and Health Administration (OSHA) can require
businesses to modify facilities and procedures to protect employees. Businesses that do not comply may be fined, forced to cease operations,
or prevented from starting operations. Signing this form is certification that the applicant, to the best of its knowledge, is in compliance with
the applicable OSHA requirements, and will remain in compliance during the life of the loan.
Civil Rights(13 C.F.R. 112, 113, 117) – All businesses receiving SBA financial assistance must agree not to discriminate in any business
practice, including employment practices and services to the public on the basis of categories cited in 13 C.F.R., Parts 112, 113, and 117 of
SBA Regulations. All borrowers must display the "Equal Employment Opportunity Poster" prescribed by SBA.
Equal Credit Opportunity Act (15 U.S.C. 1691) – Creditors are prohibited from discriminating against credit applicants on the basis of race,
color, religion, national origin, sex, marital status or age (provided the applicant has the capacity to enter into a binding contract); because all
or part of the applicant's income derives from any public assistance program; or because the applicant has in good faith exercised any right
under the Consumer Credit Protection Act.
Debarment and Suspension Executive Order 12549; (2 CFR Part 180 and Part 2700) – By submitting this loan application, you certify
that neither you nor any Associates have within the past three years been: (a) debarred, suspended, declared ineligible or voluntarily excluded
from participation in a transaction by any Federal Agency; (b) formally proposed for debarment, with a final determination still pending; (c)
indicted, convicted, or had a civil judgment rendered against you for any of the offenses listed in the regulations or (d) delinquent on any
amounts owed to the U.S. Government or its instrumentalities as of the date of execution of this certification.

4
SBA Form 2483 (03/20)


Case 1:20-cv-00177-JJM-PAS

Document 5-4
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Page 30 of 44 PageID

ATTACHMENT G


Present
Balance

Rate of Maturity
Interest
Date

Monthly
Payment
Collateral

Current or
Past Due

Is this note
being
refinanced

Is this an
SBA loan Reason for refinance

Filed 04/17/20

__________
DATE

Original Note Original
Amount
Note Date

Document 5-4
#: 191

______________________________
SIGNATURE AND TITLE

Lender

Name of Business:

DEBT SCHEDULE

Print Form

Case 1:20-cv-00177-JJM-PAS
Page 31 of 44 PageID


Case 1:20-cv-00177-JJM-PAS

Document 5-4
#: 192

Filed 04/17/20

Page 32 of 44 PageID

ATTACHMENT H


Case 1:20-cv-00177-JJM-PAS
Form

4506-T
(March 2019)

Department of the Treasury
Internal Revenue Service

Document 5-4 Filed 04/17/20
#: 193
Request for Transcript of Tax Return

Page 33 of 44 PageID

a Do not sign this form unless all applicable lines have been completed.

OMB No. 1545-1872

a Request may be rejected if the form is incomplete or illegible.
a For more information about Form 4506-T, visit www.irs.gov/form4506t.

Tip. Use Form 4506-T to order a transcript or other return information free of charge. See the product list below. You can quickly request transcripts by using
our automated self-help service tools. Please visit us at IRS.gov and click on “Get a Tax Transcript...” under “Tools” or call 1-800-908-9946. If you need a copy
of your return, use Form 4506, Request for Copy of Tax Return. There is a fee to get a copy of your return.

1a Name shown on tax return. If a joint return, enter the name
shown first.

1b First social security number on tax return, individual taxpayer identification
number, or employer identification number (see instructions)

2a If a joint return, enter spouse’s name shown on tax return.

2b Second social security number or individual taxpayer
identification number if joint tax return

3

Current name, address (including apt., room, or suite no.), city, state, and ZIP code (see instructions)

4

Previous address shown on the last return filed if different from line 3 (see instructions)

5a If the transcript or tax information is to be mailed to a third party (such as a mortgage company), enter the third party’s name, address,
and telephone number.
PONTE INVESTMENTS LLC 1300 DIVISION ROAD UNIT 305 WEST WARWICK, RI 02893 PHONE 401 398 8930 FAX: 401 633 7440 ID:jponte63
5b Customer file number (if applicable) (see instructions)

Caution: If the tax transcript is being mailed to a third party, ensure that you have filled in lines 6 through 9 before signing. Sign and date the form once
you have filled in these lines. Completing these steps helps to protect your privacy. Once the IRS discloses your tax transcript to the third party listed
on line 5a, the IRS has no control over what the third party does with the information. If you would like to limit the third party’s authority to disclose
your transcript information, you can specify this limitation in your written agreement with the third party.
Transcript requested. Enter the tax form number here (1040, 1065, 1120, etc.) and check the appropriate box below. Enter only one tax form
number per request. a

6
a

Return Transcript, which includes most of the line items of a tax return as filed with the IRS. A tax return transcript does not reflect
changes made to the account after the return is processed. Transcripts are only available for the following returns: Form 1040 series,
Form 1065, Form 1120, Form 1120-A, Form 1120-H, Form 1120-L, and Form 1120S. Return transcripts are available for the current year
and returns processed during the prior 3 processing years. Most requests will be processed within 10 business days . . . . . .

b

Account Transcript, which contains information on the financial status of the account, such as payments made on the account, penalty
assessments, and adjustments made by you or the IRS after the return was filed. Return information is limited to items such as tax liability
and estimated tax payments. Account transcripts are available for most returns. Most requests will be processed within 10 business days .

c

Record of Account, which provides the most detailed information as it is a combination of the Return Transcript and the Account
Transcript. Available for current year and 3 prior tax years. Most requests will be processed within 10 business days
. . . . . .

✔

7

Verification of Nonfiling, which is proof from the IRS that you did not file a return for the year. Current year requests are only available
after June 15th. There are no availability restrictions on prior year requests. Most requests will be processed within 10 business days . .
8
Form W-2, Form 1099 series, Form 1098 series, or Form 5498 series transcript. The IRS can provide a transcript that includes data from
these information returns. State or local information is not included with the Form W-2 information. The IRS may be able to provide this
transcript information for up to 10 years. Information for the current year is generally not available until the year after it is filed with the IRS. For
example, W-2 information for 2011, filed in 2012, will likely not be available from the IRS until 2013. If you need W-2 information for retirement
purposes, you should contact the Social Security Administration at 1-800-772-1213. Most requests will be processed within 10 business days .
Caution: If you need a copy of Form W-2 or Form 1099, you should first contact the payer. To get a copy of the Form W-2 or Form 1099 filed
with your return, you must use Form 4506 and request a copy of your return, which includes all attachments.
9

Year or period requested. Enter the ending date of the year or period, using the mm/dd/yyyy format. If you are requesting more than four
years or periods, you must attach another Form 4506-T. For requests relating to quarterly tax returns, such as Form 941, you must enter
each quarter or tax period separately.
12 / 31 / 2018
12 / 31 / 2017
12 / 31 / 2016
12 / 31 / 2015
Caution: Do not sign this form unless all applicable lines have been completed.
Signature of taxpayer(s). I declare that I am either the taxpayer whose name is shown on line 1a or 2a, or a person authorized to obtain the tax
information requested. If the request applies to a joint return, at least one spouse must sign. If signed by a corporate officer, 1 percent or more
shareholder, partner, managing member, guardian, tax matters partner, executor, receiver, administrator, trustee, or party other than the taxpayer, I
certify that I have the authority to execute Form 4506-T on behalf of the taxpayer. Note: This form must be received by IRS within 120 days of the
signature date.
Signatory attests that he/she has read the attestation clause and upon so reading declares that he/she
Phone number of taxpayer on line
has the authority to sign the Form 4506-T. See instructions.
1a or 2a
F F F

Sign
Here

Signature (see instructions)

Date

Title (if line 1a above is a corporation, partnership, estate, or trust)

Spouse’s signature

For Privacy Act and Paperwork Reduction Act Notice, see page 2.

Date
Cat. No. 37667N

Form 4506-T (Rev. 3-2019)


Case 1:20-cv-00177-JJM-PAS

Document 5-4
#: 194

Filed 04/17/20

Page 2

Form 4506-T (Rev. 3-2019)
Section references are to the Internal Revenue Code unless
otherwise noted.

Future Developments
For the latest information about Form 4506-T and its
instructions, go to www.irs.gov/form4506t. Information about
any recent developments affecting Form 4506-T (such as
legislation enacted after we released it) will be posted on that
page.
What's New. The transcripts provided by the IRS have been
modified to protect taxpayers' privacy. Transcripts only
display partial personal information, such as the last four
digits of the taxpayer's Social Security Number. Full financial
and tax information, such as wages and taxable income, is
shown on the transcript.
A new optional Customer File Number field is available to use
when requesting a transcript. You have the option of
inputting a number, such as a loan number, in this field. You
can input up to 10 numeric characters. The customer file
number should not contain an SSN. This number will print on
the transcript. The customer file number is an optional field
and not required.

General Instructions
Caution: Do not sign this form unless all applicable lines
have been completed.
Purpose of form. Use Form 4506-T to request tax return
information. You can also designate (on line 5a) a third party
to receive the information. Taxpayers using a tax year
beginning in one calendar year and ending in the following
year (fiscal tax year) must file Form 4506-T to request a return
transcript.
Note: If you are unsure of which type of transcript you need,
request the Record of Account, as it provides the most
detailed information.
Tip. Use Form 4506, Request for Copy of
Tax Return, to request copies of tax returns.
Automated transcript request. You can quickly request
transcripts by using our automated
self-help service tools. Please visit us at IRS.gov and click on
“Get a Tax Transcript...” under “Tools” or call
1-800-908-9946.
Where to file. Mail or fax Form 4506-T to
the address below for the state you lived in,
or the state your business was in, when that return was filed.
There are two address charts: one for individual transcripts
(Form 1040 series and Form W-2) and one for all other
transcripts.
If you are requesting more than one transcript or other
product and the chart below shows two different addresses,
send your request to the address based on the address of
your most recent return.

Chart for individual transcripts
(Form 1040 series and Form W-2
and Form 1099)
If you filed an
individual return and
lived in:
Alabama, Kentucky, Louisiana,
Mississippi, Tennessee,
Texas, a foreign country,
American Samoa, Puerto Rico,
Guam, the Commonwealth of
the Northern Mariana Islands,
the U.S. Virgin Islands, or
A.P.O. or F.P.O. address
Alaska, Arizona, Arkansas,
California, Colorado, Hawaii,
Idaho, Illinois, Indiana, Iowa,
Kansas, Michigan, Minnesota,
Montana, Nebraska, Nevada,
New Mexico, North Dakota,
Oklahoma, Oregon, South
Dakota, Utah, Washington,
Wisconsin, Wyoming
Connecticut, Delaware, District
of Columbia, Florida, Georgia,
Maine, Maryland,
Massachusetts, Missouri, New
Hampshire, New Jersey, New
York, North Carolina, Ohio,
Pennsylvania, Rhode Island,
South Carolina, Vermont,
Virginia, West Virginia

Page 34 of 44 PageID

Mail or fax to:

Internal Revenue Service
RAIVS Team
Stop 6716 AUSC
Austin, TX 73301

855-587-9604
Internal Revenue Service
RAIVS Team
Stop 37106
Fresno, CA 93888

Chart for all other transcripts
If you lived in
or your business was
in:

Alabama, Alaska, Arizona,
Arkansas, California,
Colorado, Connecticut,
Delaware, District of
Columbia, Florida, Georgia,
Hawaii, Idaho, Illinois,
Indiana, Iowa, Kansas,
Kentucky, Louisiana,
Internal Revenue Service
Maryland, Michigan,
RAIVS Team
Minnesota, Mississippi,
P.O. Box 9941
Missouri, Montana,
Mail Stop 6734
Nebraska, Nevada, New
Ogden, UT 84409
Jersey, New Mexico, North
Carolina, North Dakota, Ohio,
Oklahoma, Oregon, Rhode
Island, South Carolina, South
Dakota, Tennessee, Texas,
855-298-1145
Utah, Virginia, Washington,
West Virginia, Wisconsin,
Wyoming, a foreign country,
American Samoa, Puerto
Rico, Guam, the
Commonwealth of the
Northern Mariana Islands,
the U.S. Virgin Islands,
A.P.O. or F.P.O. address
Maine, Massachusetts, New
Hampshire, New York,
Pennsylvania, Vermont

Internal Revenue Service
RAIVS Team
Stop 6705 S-2
Kansas City, MO 64999

855-821-0094

Internal Revenue Service
RAIVS Team
Stop 6705 S-2
Kansas City, MO 64999
855-821-0094

Line 1b. Enter your employer identification number (EIN) if
your request relates to a business return. Otherwise, enter the
first social security number (SSN) or your individual taxpayer
identification number (ITIN) shown on the return. For
example, if you are requesting Form 1040 that includes
Schedule C (Form 1040), enter your SSN.
Line 3. Enter your current address. If you use a P.O. box,
include it on this line.
Line 4. Enter the address shown on the last return filed if
different from the address entered on line 3.
Note: If the addresses on lines 3 and 4 are different and you
have not changed your address with the IRS, file Form 8822,
Change of Address. For a business address, file Form 8822B, Change of Address or Responsible Party — Business.
Line 5b. Enter up to 10 numeric characters to create a unique
customer file number that will appear on the transcript. The
customer file number should not contain an SSN.
Completion of this line is not required.
Note. If you use an SSN, name or combination of both, we
will not input the information and the customer file number
will be blank on the transcript.
Line 6. Enter only one tax form number per
request.
Signature and date. Form 4506-T must be signed and dated
by the taxpayer listed on line 1a or 2a. The IRS must receive
Form 4506-T within 120 days of the date signed by the
taxpayer or it will be rejected. Ensure that all applicable lines
are completed before signing.

!
F
CAUTION

855-800-8105

Mail or fax to:

You must check the box in the signature area
to acknowledge you have the authority to sign
and request the information. The form will not
be processed and returned to you if the
box is unchecked.

Individuals. Transcripts of jointly filed tax returns may be
furnished to either spouse. Only one signature is required.
Sign Form 4506-T exactly as your name appeared on the
original return. If you changed your name, also sign your
current name.

Corporations. Generally, Form 4506-T can be signed by:
(1) an officer having legal authority to bind the corporation, (2)
any person designated by the board of directors or other
governing body, or (3) any officer or employee on written
request by any principal officer and attested to by the
secretary or other officer. A bona fide shareholder of record
owning 1 percent or more of the outstanding stock of the
corporation may submit a Form 4506-T but must provide
documentation to support the requester's right to receive the
information.
Partnerships. Generally, Form 4506-T can be signed by
any person who was a member of the partnership during any
part of the tax period requested on line 9.
All others. See section 6103(e) if the taxpayer has died, is
insolvent, is a dissolved corporation, or if a trustee, guardian,
executor, receiver, or administrator is acting for the taxpayer.
Note: If you are Heir at law, Next of kin, or Beneficiary you
must be able to establish a material interest in the estate or
trust.
Documentation. For entities other than individuals, you
must attach the authorization document. For example, this
could be the letter from the principal officer authorizing an
employee of the corporation or the letters testamentary
authorizing an individual to act for an estate.
Signature by a representative. A representative can sign
Form 4506-T for a taxpayer only if the taxpayer has
specifically delegated this authority to the representative on
Form 2848, line 5. The representative must attach Form 2848
showing the delegation to Form 4506-T.
Privacy Act and Paperwork Reduction Act Notice. We ask
for the information on this form to establish your right to gain
access to the requested tax information under the Internal
Revenue Code. We need this information to properly identify
the tax information and respond to your request. You are not
required to request any transcript; if you do request a
transcript, sections 6103 and 6109 and their regulations
require you to provide this information, including your SSN or
EIN. If you do not provide this information, we may not be
able to process your request. Providing false or fraudulent
information may subject you to penalties.
Routine uses of this information include giving it to the
Department of Justice for civil and criminal litigation, and
cities, states, the District of Columbia, and U.S.
commonwealths and possessions for use in administering
their tax laws. We may also disclose this information to other
countries under a tax treaty, to federal and state agencies to
enforce federal nontax criminal laws, or to federal law
enforcement and intelligence agencies to combat terrorism.
You are not required to provide the information requested
on a form that is subject to the Paperwork Reduction Act
unless the form displays a valid OMB control number. Books
or records relating to a form or its instructions must be
retained as long as their contents may become material in the
administration of any Internal Revenue law. Generally, tax
returns and return information are confidential, as required by
section 6103.
The time needed to complete and file Form 4506-T will
vary depending on individual circumstances. The estimated
average time is: Learning about the law or the form, 10
min.; Preparing the form, 12 min.; and Copying,
assembling, and sending the form to the IRS, 20 min.
If you have comments concerning the accuracy of these
time estimates or suggestions for making Form 4506-T
simpler, we would be happy to hear from you. You can write
to:
Internal Revenue Service
Tax Forms and Publications Division
1111 Constitution Ave. NW, IR-6526
Washington, DC 20224
Do not send the form to this address. Instead, see Where
to file on this page.


Case 1:20-cv-00177-JJM-PAS

Document 5-4
#: 195

Filed 04/17/20

Page 35 of 44 PageID

ATTACHMENT I


Case 1:20-cv-00177-JJM-PAS

Document 5-4 Filed 04/17/20
#: 196
SBA 7(a) Borrower
Information Form
For use with all 7(a) Programs

Page 36 of 44 PageID
OMB Control No.: 3245-0348
Expiration Date: 07/31/2020

Purpose of this form:
The purpose of this form is to collect information about the Small Business Applicant (“Applicant”) and its principals, the loan
request, indebtedness, information about current or previous government financing, and certain other topics. The information also
facilitates background checks as authorized by section 7(a)(1)(B) of the Small Business Act, 15 U.S.C. 636(a)(1)(B). This form is to
be completed by the Applicant and all individuals identified below and submitted to your SBA Participating Lender. Submission of
the requested information is required for SBA or the Lender to make a determination regarding eligibility for financial assistance.
Failure to submit the information would affect that determination.
Instructions for completing this form:
This form is divided into two sections. Section I requests information about the Small Business Applicant and must be completed in its
entirety, signed and dated by an authorized representative of the Small Business Applicant that is requesting a business loan. A
separate Section I is required to be completed and signed for each co-applicant (e.g. “Eligible Passive Company (EPC)”or
“Operating Company (OC)”).
Section II of this form requests information about each of the Small Business Applicant’s principals. This section must be completed
in its entirety, signed and dated by the following:

x For a sole proprietorship, the sole proprietor;
x For a partnership, all general partners, and all limited partners owning 20% or more of the equity of the firm; or any partner that is
involved in management of the applicant business;

x For a corporation, all owners of 20% or more of the corporation, and each officer and director;
x For limited liability companies, all members owning 20% or more of the company, each officer, director, and managing member;
x Any Person hired by the business to manage day-to-day operations (“key employee”); and
x Any Trustor (if the Small Business Applicant is owned by a trust).
All parties listed above are considered “Associates” of the Small Business Applicant as defined in 13 CFR § 120.10, as well as
“principals.” A separate Section II is required to be completed and signed by each principal of the Small Business Applicant.
For clarification regarding any of the questions, please contact your Lender.

Definitions:
1.

Affiliation – Concerns and entities are affiliates of each other when one controls or has the power to control the other, or a
third party (or parties) controls or has power to control both. For example, affiliation may arise through ownership,
common management (including through a management agreement), or when there is an identity of interest between close
relatives with identical, or substantially identical, business interests. The complete definition of “affiliation” is found at 13
CFR § 121.301(f).

2.

Close Relative - Close Relative is a spouse; a parent; or a child or sibling, or the spouse of any such person.

3.

Eligible Passive Company (“EPC”) – is a small entity or trust which does not engage in regular and continuous business
activity which leases real or personal property to an Operating Company for use in the Operating Company’s business, and
which complies with the conditions set forth in 13 CFR § 120.111.

4.

Household Member – A “household member” of an SBA employee includes: a) the spouse of the SBA employee; b) the
minor children of said individual; and c) the blood relatives of the employee, and the blood relatives of the employee’s
spouse who reside in the same place of abode as the employee. [13 CFR § 105.201(d)]

5.

Operating Company (“OC”) – is an eligible small business actively involved in conducting business operations now or
about to be located on real property owned by an Eligible Passive Company, or using or about to use in its business
operations personal property owned by an Eligible Passive Company.

SBA Form 1919 (05/17)

1


Case 1:20-cv-00177-JJM-PAS

Document 5-4 Filed 04/17/20
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SBA 7(a) Borrower
Information Form

Page 37 of 44 PageID
OMB Control No.: 3245-0348

(Section I: Applicant Business Information)
✔ OC / ‰ EPC)
Applicant Business Legal Name (‰

Expiration Date: 07/31/2020

DBA or Tradename if applicable

Applicant Business Primary Business Address

Applicant Business Tax ID

Applicant Business Phone

(
Project Address (if other than primary business address)

Primary Contact

)

-

Email Address

# of existing employees employed by business? (including owners):
# of jobs to be created as a result of the loan? (including owners):
# of jobs that will be retained as a result of the loan that otherwise would have been lost? (including owners):

Amount of Loan Request:

$

Purpose of the loan:
Small Business Applicant Ownership
List all proprietors, partners, officers, directors, and holders of outstanding stock. 100% of ownership must be reflected. Attach a separate sheet if
necessary. Based on this form’s instructions not all owners will need to complete the Principal Information section of this form.
Owner Name

Title

Ownership %

Address

Unless stated otherwise, if any of the questions below are answered “Yes,” please provide details on a separate sheet.
#

Question

Yes

No

1

Are there co-applicants? (If “Yes,” please complete a separate Section I: Applicant Business Information for each.)

‰

‰

2

Has an application for the requested loan ever been submitted to the SBA, a lender, or a Certified Development Company, in
connection with any SBA program? (If “Yes,” provide details.)

‰

‰

3

Is the Small Business Applicant presently suspended, debarred, proposed for debarment, declared ineligible, or voluntarily
excluded from participation in this transaction by any Federal department or agency?

‰

‰

4

Does the Small Business Applicant operate under a Franchise/License/Distributor/Membership/Dealer/
Jobber or other type of Agreement? (If “Yes,” provide copies of your agreement(s) and any other relevant documents.)

‰

‰

5

Does the Small Business Applicant have any Affiliates? (If “Yes,” please attach a listing of all Affiliates.)

‰

‰

6

Has the Small Business Applicant and/or its Affiliates ever filed for bankruptcy protection?

‰

‰

7

Is the Small Business Applicant and/or its Affiliates presently involved in any pending legal action?

‰

‰

8

Has the Small Business Applicant and/or its Affiliates ever obtained a direct or guaranteed loan from SBA or any other Federal
agency or been a guarantor on such a loan?

‰

‰

a)

If you answered “Yes” to Question 8, is any of the financing currently delinquent?

‰

‰

b)

If you answered “Yes” to Question 8, did any of this financing ever default and cause a loss to the Government?

‰

‰

‰

‰

10 Is the Small Business Applicant using (or intending to use) a packager, broker, accountant, lawyer, etc. to assist in (a) preparing
the loan application or any related materials and/or (b) referring the loan to the lender?

‰
✔

‰

11 Are any of the Small Business Applicant’s revenues derived from gambling, loan packaging, or from the sale of products or
services, or the presentation of any depiction, displays or live performances, of a prurient sexual nature?

‰

‰

9

Are any of the Small Business Applicant’s products and/or services exported or is there a plan to begin exporting as a result of
this loan?
If ”Yes,” provide the estimated total export sales this loan will support:

SBA Form 1919 (05/17)

2

✔

$

✔


Case 1:20-cv-00177-JJM-PAS

Document 5-4 Filed 04/17/20
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SBA 7(a) Borrower
Information Form

Page 38 of 44 PageID

(Section I: Applicant Business Information)

OMB Control No.: 3245-0348
Expiration Date: 07/31/2020

#

True

False

12 No SBA employee, or the household member (see definition on page 1) of an SBA employee, is a sole proprietor, partner,
officer, director, or stockholder with a 10 percent or more interest, of the Applicant. [13 CFR 105.204]

‰
✔

‰

13 No former SBA employee, who has been separated from SBA for less than one year prior to the request for financial assistance,
is an employee, owner, partner, attorney, agent, owner of stock, officer, director, creditor or debtor of the Applicant. [13 CFR
105.203]

‰
✔

‰

14 No member of Congress, or an appointed official or employee of the legislative or judicial branch of the Federal Government, is
a sole proprietor, general partner, officer, director, or stockholder with a 10 percent or more interest, or household member of
such individual, of the Applicant. [13 CFR 105.301(c)]

‰
✔

‰

15 No Government employee having a grade of at least GS-13 or higher is a sole proprietor, general partner, officer, director, or
stockholder with a 10 percent or more interest, or a household member of such individual, of the Applicant. [13 CFR
105.301(a)]

‰
✔

‰

16 No member or employee of a Small Business Advisory Council or a SCORE volunteer is a sole proprietor, general partner,
officer, director, or stockholder with a 10 percent or more interest, or a household member of such individual, of the Applicant.
[13 CFR 105.302(a)]

‰

‰

SBA may not provide financial assistance to an applicant where there is any appearance of a conflict of interest with an SBA or other
governmental employee.

✔

By Signing Below, You Make the Following Representations and Certifications
REPRESENTATIONS
I represent that:
x
x
x
x

I have read the Statements Required by Law and Executive Order included in this form, and I understand them.
I will comply, whenever applicable, with the hazard insurance, lead-based paint, civil rights and other limitations in this
form.
All SBA loan proceeds will be used only for business related purposes as specified in the loan application.
To the extent feasible, I will purchase only American-made equipment and products.

ACCURACY CERTIFICATION
I certify that the information provided in this application and the information that I have provided in all supporting documents
and forms is true and accurate. I realize that the penalty for knowingly making a false statement to obtain a guaranteed loan from
SBA is that I may be fined up to $250,000 and/or be put in jail for up to 5 years under 18 USC § 1001 and if false statements are
submitted to a Federally insured institution, I may be fined up to $1,000,000 and/or be put in jail for up to 30 years under 18 USC §
1014.

___________________________________________________
Signature of Authorized Representative of Applicant Business

______________________
Date

_____________________________________________________
Print Name

_______________________
Title

SBA Form 1919 (05/17)

3


Case 1:20-cv-00177-JJM-PAS

Document 5-4 Filed 04/17/20
#: 199
SBA 7(a) Borrower
Information Form

Page 39 of 44 PageID
OMB Control No.: 3245-0348

(Section II: Principal Information)
Social Security Number or
Tax ID if an Entity

Principal Name

Expiration Date: 07/31/2020

Date of Birth

/
Home Address

Place of Birth
(City & State or Foreign Country)

/

Home Phone

(

)

% of Ownership in the
Small Business Applicant

-

Veteran/Gender/Race/Ethnicity data is collected for program reporting purposes only.
Disclosure is voluntary and has no bearing on the credit decision.
Enter Response Below

Veteran
Gender
Race (more than 1
may be selected)
Ethnicity

1=Non-Veteran; 2=Veteran; 3=Service-Disabled Veteran; 4=Spouse of Veteran; X=Not Disclosed
M=Male; F=Female; X=Not Disclosed
1=American Indian or Alaska Native; 2=Asian; 3=Black or African-American; 4=Native Hawaiian or
Pacific Islander; 5=White; X=Not Disclosed
H=Hispanic or Latino; N=Not Hispanic or Latino; X=Not Disclosed

Unless stated otherwise, if any of the questions below are answered “Yes,” please provide details on a separate sheet.

#
17

Question

Yes

Are you presently subject to an indictment, criminal information, arraignment, or other means by which formal
criminal charges are brought in any jurisdiction? (If “Yes,” the loan request is not eligible for SBA assistance.)
Initial here to confirm your response to question 17 Î

18

Have you been arrested in the last 6 months for any criminal offense?
Initial here to confirm your response to question 18 Î

19

For any criminal offense – other than a minor vehicle violation – have you ever: 1) been convicted; 2) pleaded guilty;
3) pleaded nolo contendere; 4) been placed on pretrial diversion; or 5) been placed on any form of parole or probation
(including probation before judgment)?
Initial here to confirm your response to question 19 Î

No

‰
‰
_____
‰
‰
_____
‰

‰

_____

If you answer “Yes” to questions 18 or 19, you must complete SBA Form 912, “Statement of Personal History.” You will need to furnish details,
including dates, location, fines, sentences, level of charge (whether misdemeanor or felony), dates of parole/probation, unpaid fines or penalties,
name(s) under which charged, and any other pertinent information. If you answer “Yes” to question 19 and are currently on parole or probation,
the loan request is not eligible for SBA assistance.
20

Are you presently suspended, debarred, proposed for debarment, declared ineligible, or voluntarily excluded from
participation in this transaction by any Federal department or agency?

‰

‰

21

If you are a 50% or more owner of the Small Business Applicant, are you more than 60 days delinquent on any
obligation to pay child support arising under an administrative order, court order, repayment agreement between the
holder and a custodial parent, or repayment agreement between the holder and a state agency providing child support
enforcement services.

‰

‰

22

‰ I am a U.S. Citizen OR ‰ I have Lawful Permanent Resident status

‰ I am not a U.S. Citizen or Lawful Permanent Resident

Registration Number:

Country of Citizenship:
Initial here to confirm your responses to question 22 Î

_____

23

Do you have any ownership in other businesses which would be defined as an Affiliate in the definition found on page
1? (If “Yes,” attach a listing of all businesses and your ownership percentage or position in the business.)

‰

‰

24

Have you, or any business you controlled, ever filed for bankruptcy protection?

‰

‰

25

Are you, or any business you control, presently involved in any legal action (including divorce)?

‰

‰

26

Have you or any business owned or controlled by you ever obtained a direct or guaranteed loan from SBA or any other
Federal agency or been a guarantor on such a loan? (This includes student loans.)

‰

‰

(a) If you answered “Yes” to Question 26, is any of the financing currently delinquent?

‰

‰

(b) If you answered “Yes” to Question 26, did any of this financing ever default and cause a loss to the Government?
(If Yes to (a) or (b) above, please provide Lender with a written explanation.)

‰

‰

SBA Form 1919 (05/17)

4


Case 1:20-cv-00177-JJM-PAS

Document 5-4 Filed 04/17/20
#: 200
SBA 7(a) Borrower
Information Form
(Section II: Principal Information)

Page 40 of 44 PageID
OMB Control No.: 3245-0348
Expiration Date: 07/31/2020

By Signing Below, You Make the Following Representations, Authorizations, and Certifications

REPRESENTATIONS AND AUTHORIZATIONS
I represent that:
•
•
•
•

I have read the Statements Required by Law and Executive Order and I understand them.
I will comply, whenever applicable, with the hazard insurance, lead-based paint, civil rights or other limitations in this form.
All SBA loan proceeds will be used only for business related purposes as specified in the loan application.
To the extent feasible, I will purchase only American-made equipment and products.

I authorize the SBA to request criminal record information about me from criminal justice agencies for the purpose of determining my
eligibility for programs authorized by the Small Business Act, as amended.
ACCURACY CERTIFICATION
I certify that the information provided in this application and the information that I have provided in all supporting documents and
forms is true and accurate. I realize that the penalty for knowingly making a false statement to obtain a guaranteed loan from SBA is
that I may be fined up to $250,000 and/or be put in jail for up to 5 years under 18 USC § 1001 and if false statements are submitted to
a Federally insured institution, I may be fined up to $1,000,000 and/or be put in jail for up to 30 years under 18 USC § 1014.

_______________________________________
Signature

__________________
Date

__________________________________________
Print Name/Title

SBA Form 1919 (05/17)

5


Case 1:20-cv-00177-JJM-PAS

Document 5-4 Filed 04/17/20
#: 201
SBA 7(a) Borrower
Information Form

Statements Required by Law and Executive Order

Page 41 of 44 PageID
OMB Control No.: 3245-0348
Expiration Date: 07/31/2020

Please read the following notices regarding use of federal financial assistance programs and then sign and date the certification.

SBA is required to withhold or limit financial assistance, to impose special conditions on approved loans, to provide special notices to applicants or
borrowers and to require special reports and data from borrowers in order to comply with legislation passed by the Congress and Executive Orders
issued by the President and by the provisions of various inter-agency agreements. SBA has issued regulations and procedures that implement these
laws and executive orders. These are contained in Parts 112, 113, and 117 of Title 13 of the Code of Federal Regulations and in Standard Operating
Procedures.
Privacy Act (5 U.S.C. 552a) -- Under the provisions of the Privacy Act, you are not required to provide your social security number. Failure to
provide your social security number may not affect any right, benefit or privilege to which you are entitled. Disclosures of name and other personal
identifiers are, however, required for a benefit, as SBA requires an individual seeking assistance from SBA to provide it with sufficient information
for it to make a character determination. In determining whether an individual is of good character, SBA considers the person’s integrity, candor,
and disposition toward criminal actions. Additionally, SBA is specifically authorized to verify your criminal history, or lack thereof, pursuant to
section 7(a)(1)(B), 15 USC Section 636(a)(1)(B) of the Small Business Act ( the Act). Further, for all forms of assistance, SBA is authorized to
make all investigations necessary to ensure that a person has not engaged in acts that violate or will violate the Act or the Small Business
Investment Act, 15 USC Sections 634(b)(11) and 687(b)(a), respectively. For these purposes, you are asked to voluntarily provide your social
security number to assist SBA in making a character determination and to distinguish you from other individuals with the same or similar name or
other personal identifier.
Any person can request to see or get copies of any personal information that SBA has in his or her file when that file is retrieved by individual
identifiers such as name or social security numbers. Requests for information about another party may be denied unless SBA has the written
permission of the individual to release the information to the requestor or unless the information is subject to disclosure under the Freedom of
Information Act.
The Privacy Act authorizes SBA to make certain “routine uses” of information protected by that Act. One such routine use is the disclosure of
information maintained in SBA’s system of records when this information indicates a violation or potential violation of law, whether civil, criminal,
or administrative in nature. Specifically, SBA may refer the information to the appropriate agency, whether Federal, State, local or foreign, charged
with responsibility for, or otherwise involved in investigation, prosecution, enforcement or prevention of such violations. Another routine use is
disclosure to other Federal agencies conducting background checks; only to the extent the information is relevant to the requesting agencies'
function. See, 74 F.R. 14890 (2009), and as amended from time to time for additional background and other routine uses.
Right to Financial Privacy Act of 1978 (12 U.S.C. 3401) -- This is notice to you as required by the Right to Financial Privacy Act of 1978, of
SBA's access rights to financial records held by financial institutions that are or have been doing business with you or your business, including any
financial institutions participating in a loan or loan guaranty. The law provides that SBA shall have a right of access to your financial records in
connection with its consideration or administration of assistance to you in the form of a Government guaranteed loan. SBA is required to provide a
certificate of its compliance with the Act to a financial institution in connection with its first request for access to your financial records, after which
no further certification is required for subsequent accesses. The law also provides that SBA's access rights continue for the term of any approved
loan guaranty agreement. No further notice to you of SBA's access rights is required during the term of any such agreement. The law also
authorizes SBA to transfer to another Government authority any financial records included in an application for a loan, or concerning an approved
loan or loan guarantee, as necessary to process, service or foreclose on a loan guaranty or collect on a defaulted loan guaranty.
Freedom of Information Act (5 U.S.C. 552) -- This law provides, with some exceptions, that SBA must supply information reflected in agency
files and records to a person requesting it. Information about approved loans that will be automatically released includes, among other things,
statistics on our loan programs (individual borrowers are not identified in the statistics) and other information such as the names of the borrowers
(and their officers, directors, stockholders or partners), the collateral pledged to secure the loan, the amount of the loan, its purpose in general terms
and the maturity. Proprietary data on a borrower would not routinely be made available to third parties. All requests under this Act are to be
addressed to the nearest SBA office and be identified as a Freedom of Information request.
Flood Disaster Protection Act (42 U.S.C. 4011) -- Regulations have been issued by the Federal Insurance Administration (FIA) and by SBA
implementing this Act and its amendments. These regulations prohibit SBA from making certain loans in an FIA designated floodplain unless
Federal Flood insurance is purchased as a condition of the loan. Failure to maintain the required level of flood insurance makes the applicant
ineligible for any financial assistance from SBA, including disaster assistance.
Executive Orders -- Floodplain Management and Wetland Protection (42 F.R. 26951 and 42 F.R. 26961) -- SBA discourages settlement in or
development of a floodplain or a wetland. This statement is to notify all SBA loan applicants that such actions are hazardous to both life and
property and should be avoided. The additional cost of flood preventive construction must be considered in addition to the possible loss of all assets
and investments due to a future flood.
Occupational Safety and Health Act (15 U.S.C. 651 et seq.) -- This legislation authorizes the Occupational Safety and Health Administration in
the Department of Labor to require businesses to modify facilities and procedures to protect employees or pay penalty fees. Businesses can be
forced to cease operations or be prevented from starting operations in a new facility. Therefore, SBA may require additional information from an
applicant to determine whether the business will be in compliance with OSHA regulations and allowed to operate its facility after the loan is
approved and disbursed. Signing this form as an applicant is certification that the OSHA requirements that apply to the applicant business have been
determined and that the applicant, to the best of its knowledge, is in compliance. Furthermore, applicant certifies that it will remain in compliance
during the life of the loan.

SBA Form 1919 (05/17)

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SBA 7(a) Borrower
Information Form

Statements Required by Law and Executive Order

Page 42 of 44 PageID
OMB Control No.: 3245-0348
Expiration Date: 07/31/2020

Civil Rights Legislation (13 C.F.R. 112, 113, 117) -- All businesses receiving SBA financial assistance must agree not to discriminate in any
business practice, including employment practices and services to the public on the basis of categories cited in 13 C.F.R., Parts 112, 113, and 117
of SBA Regulations. This includes making their goods and services available to handicapped clients or customers. All business borrowers will be
required to display the "Equal Employment Opportunity Poster" prescribed by SBA.
Equal Credit Opportunity Act (15 U.S.C. 1691) -- The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against
credit applicants on the basis of race, color, religion, national origin, sex, marital status or age (provided the applicant has the capacity to enter into a
binding contract); because all or part of the applicant's income derives from any public assistance program, or because the applicant has in good
faith exercised any right under the Consumer Credit Protection Act.
Executive Order 11738 -- Environmental Protection (38 F.R. 251621) -- The Executive Order charges SBA with administering its loan programs
in a manner that will result in effective enforcement of the Clean Air Act, the Federal Water Pollution Act and other environment protection
legislation.
Debt Collection Act of 1982, Deficit Reduction Act of 1984 (31 U.S.C. 3701 et seq. and other titles) -- These laws require SBA to collect
aggressively any loan payments which become delinquent. SBA must obtain your taxpayer identification number when you apply for a loan. If you
receive a loan, and do not make payments as they come due, SBA may take one or more of the following actions: (1) report the status of your
loan(s) to credit bureaus, (2) hire a collection agency to collect your loan, (3) offset your income tax refund or other amounts due to you from the
Federal Government, (4) suspend or debar you or your company from doing business with the Federal Government, (5) refer your loan to the
Department of Justice or other attorneys for litigation, or (6) foreclose on collateral or take other action permitted in the loan instruments.
Immigration Reform and Control Act of 1986 (Pub. L. 99-603) -- If you are an alien who was in this country illegally since before January 1,
1982, you may have been granted lawful temporary resident status by the United States Immigration and Naturalization Service pursuant to the
Immigration Reform and Control Act of 1986. For five years from the date you are granted such status, you are not eligible for financial assistance
from the SBA in the form of a loan guaranty under Section 7(a) of the Small Business Act unless you are disabled or a Cuban or Haitian entrant.
When you sign this document, you are making the certification that the Immigration Reform and Control Act of 1986 does not apply to you, or if it
does apply, more than five years have elapsed since you have been granted lawful temporary resident status pursuant to such 1986 legislation.
Lead-Based Paint Poisoning Prevention Act (42 U.S.C. 4821 et seq.) -- Borrowers using SBA funds for the construction or rehabilitation of a
residential structure are prohibited from using lead-based paint (as defined in SBA regulations) on all interior surfaces, whether accessible or not,
and exterior surfaces, such as stairs, decks, porches, railings, windows and doors, which are readily accessible to children under 7 years of age. A
"residential structure" is any home, apartment, hotel, motel, orphanage, boarding school, dormitory, day care center, extended care facility, college
or other school housing, hospital, group practice or community facility and all other residential or institutional structures where persons reside.
Executive Order 12549, Debarment and Suspension (2 CFR 180, adopted by reference in 2 CFR Part 2700 (SBA Debarment Regulations))
-- By submission of this loan application, you certify and acknowledge that neither you nor any Principals have within the past three years been: (a)
debarred, suspended, declared ineligible from participating in, or voluntarily excluded from participation in a transaction by any Federal department
or agency; (b) formally proposed for debarment, with a final determination still pending; (c) indicted, convicted, or had a civil judgment rendered
against you for any of the offenses listed in the Regulations; or (d) delinquent on any amounts due and owing to the U.S. Government or its agencies
or instrumentalities as of the date of execution of this certification.
If you are unable to certify and acknowledge (a) through (d), you must obtain and attach a written statement of exception from SBA permitting
participation in this loan. You further certify that you have not and will not knowingly enter into any agreement in connection with the goods
and/or services purchased with the proceeds of this loan with any individual or entity that has been debarred, suspended, declared ineligible from
participating in, or voluntarily excluded from participation in a Transaction. All capitalized terms have the meanings set forth in 2 C.F.R. Part 180.

NOTE: According to the Paperwork Reduction Act, you are not required to respond to this collection of information unless it displays a currently
valid OMB Control Number. The estimated burden for completing this form, including time for reviewing instructions, gathering data needed, and
completing and reviewing the form is 8 minutes per response. Comments or questions on the burden estimates should be sent to U.S. Small
Business Administration, Director, Records Management Division, 409 3rd St., SW, Washington DC 20416, and/or SBA Desk Officer, Office of
Management and Budget, New Executive Office Building, Rm. 10202, Washington DC 20503.
PLEASE DO NOT SEND FORMS TO THESE ADDRESSES.
SBA Form 1919 (05/17)

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Filed 04/17/20

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ATTACHMENT J


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