Court filing

Exhibit 8 — USA v. Crowther (Dkt. 136.6)

Summary

SBA Form 2483 (03/20), the Paycheck Protection Program Application Form, filed March 31, 2021 as Doc. 136-6, Exhibit 8 in USA v. Crowther, No. 2:20-cr-00114, in the U.S. District Court for the Middle District of Florida. The form lists Target Roofing and Sheet Metal Inc. as the business legal name, Number of Jobs 135, and an ownership entry for Casey Crowther, President, 100%. Its yes/no questions ask about suspension or debarment, delinquent federal loans, an SBA Economic Injury Disaster Loan, indictment and felony history. The second page sets out certifications and has signature lines for an authorized representative and an owner.

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Filed March 31, 2021 in USA v. Crowther; one of 365 filings from this case.

Record facts

Court	U.S. District Court for the Middle District of Florida
Filed	2021-03-31

Cite this document

“Exhibit 8 — USA v. Crowther (Dkt. 136.6).” U.S. District Court for the Middle District of Florida, No. 2:20-cr-00114, Doc. 136-6, filed 2021-03-31. Archived at Pandemic Darlings, https://pandemicdarlings.com/court-filings/full-docket-casey-david-crowther-flmd-381779/2021-03-31-gov-uscourts-flmd-381779-136-6-doc-136-6/, SHA-256 e72669d75acf32e08f75bb95760c135c8477ce004274e419b1280cc76e9f5f28.

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Case 2:20-cr-00114-JES-M_M Document136-6 Filed 03/31/21 Page 1 of 2 PagelD ;

OMB Control No; 324$-

Paycheck Protection Program
Expiration Date: 06/30/2020

Application Form

Non-Profit0 Vet OrgO Tribal O Ind. Cont. D Self Employed O DBA or Tradename if applicable

Business Legal Name
Target Roofing and Sheet Metal Inc.

Business Primary Address Busi TIN (EIN,SSN) Busi Phone
1841 Ortiz Ave 47-4767409 | 239 332-5707
Primary Contact Email Address
Fort Myers FL 33905 Brad North brad@targetroofers.com

Average Monthly Payroll: | $839 ; 503 X 2.5 equals Loan Amount: | $ 2, 098,759 Number of Jobs: | 135

Purpose of the loan

(select more than one): | fi Payroll _flRent / Mortgage Interest_ Utilities [Other (explain):

Applicant Ownership

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

Owner Name Title rship % TIN (EIN,SSN) Address
Casey Crowther President 100% 6651 Nalle Grade Road, N Fort Myers 33917

een Question 7 | ¥es | No |

1. Is the Business or any awner presently suspended, debarred, proposed for debarment, declared ineligible, voluntarily excluded
from participation in this transaction by any Federal department or agency, or presenily involved in any bankruptcy? [|

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, FA
attach a listing of all Affiliates and describe the relationship as addendum A. ¥

4. Has the Business reccived an SBA Economic Injury Disaster Loan between January 31, 2020 and Apri! 3, 2020? If yes,
provide details on a separate sheet identified as addendum B. [|

in will not be

| Question | Yes} No |
5. 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?
Initial here to confirm your response to question 5 ¢ P :
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)? é
Initial here to confirm your response to question 6 > (.
7. Ml tama U.S. Citizen OR [7 thave Lawful Permanent Resident status LJ No
Initial here to confirm your response to question 7 C Cc

SBA Form 2483 (03/20) EX_8 001
Case 2:20-cr-00114-JES-M_M Document 136-6 Filed 03/31/21 Page 2 of 2 PagelD

1576
Lg Paycheck Protection Program OMB Control No. 3245-
Ce ia Application Form Expiration Date: 06/30/2020

I represent that:
@ I have read the Statements Required by Law and Executive Order included in this form, and I understand them.
| will comply, whenever applicable, with the 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.
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 cach 20% or greater owner must certify in good faith to all of the below by initialing next to each onc:
Ce 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 govemment 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.

1 further certify that the information provided in this application and the information that | have provided in all supporting,
documents and forms is true and accurate, | 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.

| acknowledge that the lender will calculate the cligible loan amount using tax documents I have submitted. | affirm that these
tax documents are identical to those | submitted to the IRS. | 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 Inspector
Gencral, 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 aw