Exhibit 12 — USA v. Crowther (Dkt. 136.9)

Summary

Exhibit 12 in USA v. Crowther (Document 136-9, filed 03/31/21) is an SBA Form 1050 Settlement Sheet for SBA Loan Number 71127970-04, a loan from Sanibel Captiva Community Bank to Target Roofing and Sheet Metal, Inc. with a note amount of $2,098,700.00. The form lists the use of proceeds as other CARES Act uses described in an attachment, and is signed on April 14, 2020 by Kyle Decicco, Senior Vice President, for the lender and Casey D Crowther, President, for the borrower, certifying that the proceeds were disbursed and will be used in accordance with the authorization. The attachment lists the authorized uses: payroll costs, group health care benefits, business mortgage interest, rent, utilities, interest on debts incurred before February 15, 2020 and refinancing an SBA EIDL loan.

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[illegible] Filed 03/31/21 Page 1 of 3 [illegible]
OMB Approval No.: 3245-0200
Expiration Date: 04/30/2022
SBA FORM 1050, SETTLEMENT SHEET
Purpose: The purpose ofthis form is to document and verify that loan proceeds have been disbursed in accordance with the
Authorization and to document that the Borrower's contribution has been injected into the business prior to the Lender disbursing
any loan proceeds.
General Instructions: This form may be used for all 7(a) loans and for all disbursements. It must be used for the first
disbursement on all standard 7(a) loans over $350,000.
This form is to be completed by the Lender and signed by the Lender and the Borrower at the time ofthe initial loan
disbursement. The Lender must retain a copy of the signed form in its loan file. For all disbursements, the Lender must also
retain documentation that is acceptable to SBA (such as joint payee checks, cancelled checks, paid receipts or invoices, wire
transfer account records, etc.) and that evidences compliance with the Use of Proceeds section ofthe Authorization.
The Lender must submit the completed form and all supporting documentation to SBA upon request, or, in the event ofa loan
default, with the [illegible] request for guaranty purchase.
Providing this information is required to comply with program requirements; failure to provide itwhen required may
impair the [illegible] ability to collect on the SBA loan guaranty.
[illegible] space is required to complete the form or provide additional details please attach a separate sheet.
Specific Instructions for Completing the Form:
1) In the first section, fill in all identifying information. [illegible] Type,” check the box to indicate whether the loan is a term loan
or a revolving line of credit.
2) Complete the “Use of Proceeds” section with information related to the initial disbursement.
a) Onthe line associated with each applicable use of proceeds, indicate:
i) The name ofthe payee (must identify the ultimate recipient, not an intermediary such as a title company);
ii) Amount disbursed; and
iii) Remaining amount to be disbursed, in accordance with the Authorization.
b) [illegible] “Settlement charges/out of pocket costs” line, insert total amount of settlement charges and other out of pocket
costs in the appropriate field within the grid. Attach an itemized list of all charges and costs, including the name of
payee and amount paid foreach charge or cost. Reminder: SBA
Form 159 is required for all fees paid or to be paid by the Lender (except Lender Service Provider fees) and for all fees
paid or to be paid by the Applicant to any agent in connection with the SBA loan application.)
c) [illegible] (Explain),” enter any other use of proceeds authorized in the Authorization that is not already listed in
the grid, ifapplicable.
3) Complete the “Borrower's Injection” section.
a) For each type of injection, indicate the source.
b) Ifthe Seller contributed toward required equity, attach a copy ofthe Note and evidence of full standby for the
life of the loan.
c) Note: The Borrower's Injection must be inthe business bank account prior to any disbursement of
loan proceeds.
4) The Lender and the Borrower must review the certification and execute the form inthe space provided.
SBA Form 1050 (04-19) Previous Editions Obsolete Page 1 [illegible]
EX_12_001
+ [illegible] ARGS [illegible] Filed 03/31/21 Page 2 of 3 PageID
1586
U.S. Small Business EXPIRATION DATE: [illegible]
Settlement Sheet
SBA Loan Number Lender Name 7021031
71127970-04 SANIBEL CAPTIVA COMMUNITY BANK
SBA Loan Name Note Amount
TARGET ROOFING AND SHEET METAL, INC. $2,098,700.00
Loan Type: [illegible] Term Loan Ol Line of Credit [illegible] Type: O First Disbursement oO Subsequent Disbursement Ri Full Disbursement
Authorized Amount
Authorized Use of Proceeds: Name _of Payee: Amount Disbursed: Remaining:
Land Acquisition: [illegible] Raw [illegible]
Constructi New [7] Expansion/Renovation is [illegible]
Leasehold Improvements to property owned by others le le
Machinery & Equipment ls ls
[illegible] & Fixtures ls ls
Inventory Purchase [illegible] ls
Working Capital ls ls
Acquire Business (Change of Ownership) [illegible] —
SBA Guarantee Fee U.S. Small Business Administration is
Settlement Charges/Out of Pocket Costs ls
Other (Explain): See Attached CARES Act uses lo oss 700,00 ls
Total: [illegible]
Borrower's Injection (including any deposit or earnest money):
Cash Source
Assets Source
Seller contribution toward required equity (on full standby for life of loan)
Other (Explain):
Total Borrower Injection:|§
At the time of completion of this form, the Lender and the Borrower certify that:
1. The loan proceeds were disbursed and received and will be used in accordance with the Use of Proceeds section of the Authorization, including any and
all SBA/Lender approved modifications, and that all required equity or Borrower injections have been made in accordance with the Authorization and any
approved modifications; and
2. There has been no unremedied adverse change in the Borrower's or Operating Company's financial condition, organization, management, operations or assets
since the date of application that would warrant withholding or not making this disbursement or any further disbursement.
Atthe time of each subsequent disbursement on this [illegible] the Lender, by disbursing the loan proceeds, and the Borrower by receiving them, are deemed to
certify that the above certifications are true with respect to each and every disbursement made.
WARNING: By signing below you are certifying that the above statements are accurate to the best of your knowledge. Submitting false information to the [illegible]
may result in criminal prosecution and fines up to $250,000 and/or imprisonment for up to 5 years under 18 USC § 1001. Submitting false statements to a Federally
insured institution may result in fines up to $1,000,000 and/or imprisonment for up to 30 years under 18 USC § 1014, penalties under 15 USC § 645, and/or civil fraud
liability.
Authorized Lender Official Borrower
[illegible] by: Docstigned by:
[illegible] (¢ sey (rout
Signature: [fe [illegible] Signature: [illegible]
Print Name: KYLE DECICCO Print Name: CASEY D CROWTHER
Title: Senior Vice President Title: President
Date: April 14, 2020 Date: April 14, 2020
SBA Form 1050 (04-19) Previous Editions Obsolete Page 2 [illegible]
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, and gathering data needed, is 30 minutes. Comments or questions on the burden estimates or other aspects of this
information collection should be sent to U.S. Small Business Administration, Director, RMD, 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 THE COMPLETED FORMS TO THESE ADDRESSES. EX 12 002
[illegible] * Case 2:20-cr-00114-JES-M_ Document 136-9 Filed 03/31/21 Page 3 of 3 PageID
* DocuSign Envelope ID: [illegible]
ATTACHMENT TO SBA FORM 1050
USE OF PROCEEDS
SBA LOAN NUMBER: 71127970-04
Payroll costs
Costs related to the continuation of group health care benefits during periods of paid sick, medical, or
family leave, and insurance premiums
Business related mortgage interest payments (but not mortgage prepayments or principal payments)
Rent payments
Utility payments
Interest payments on any other debt obligations that were incurred before February 15, 2020
Refinancing an SBA EIDL loan made between January 31, 2020 and April 3, 2020
EX 12 003


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