Exhibit — PPP Borrower Application Form, United States v. Shibley (Dkt. 137-5)

Record facts

U.S. District Court for the Western District of Washington · No. 2:20-cr-00174-JCC · Doc. 137-5 · 2021-11-26 · Docket on CourtListener

Summary

A government exhibit filed in United States v. Shibley, No. 2:20-cr-00174-JCC, in the U.S. District Court for the Western District of Washington, entered November 26, 2021 as Document 137-5. It reproduces SBA Form 2483, the Paycheck Protection Program Borrower Application Form, with its checkboxes for business type, fields for average monthly payroll, loan request, number of employees and owners of 20 percent or more, and eight eligibility questions covering debarment, delinquent federal loans, affiliated businesses, prior disaster loans, pending criminal charges and felony history. The certifications page sets out representations on eligibility, use of funds and forgiveness, and cites penalty provisions including 18 USC 1001. A signature block is dated April 25, 2020 and signed by Eric R Shibley as Manager. The exhibit runs 34 pages and is marked Government Exhibit No. 14.

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Paycheck Protection Program 
Borrower Application Form 
1 
SBA Form 2483 (04/20) 
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Check One: 
Sole proprietor    Partnership    C-Corp    S-Corp    LLC
Independent contractor   Eligible self-employed individual
501(c)(3) nonprofit    501(c)(19) veterans organization
Tribal business (sec. 31(b)(2)(C) of Small Business Act)    Other
DBA or Tradename if Applicable 
Business Legal Name 
Business Address 
Business TIN (EIN, SSN) 
Business Phone 
(     )        - 
Primary Contact 
Email Address 
Average Monthly Payroll: 
$ 
 x 2.5 + EIDL, Net of 
Advance (if Applicable) 
Equals Loan Request: 
$ 
Number of Employees: 
Purpose of the loan 
  (select more than one): 
☐Payroll ☐Lease / Mortgage Interest ☐Utilities ☐Other (explain):__________________
Applicant Ownership 
List all owners of 20% or more of the equity of the Applicant. 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 Applicant or any owner of the Applicant 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 Applicant, any owner of the Applicant, 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 Applicant or any owner of the Applicant an owner of any other business, or have common management with, any other
business? If yes, list all such businesses and describe the relationship on a separate sheet identified as addendum A.
4.
Has the Applicant 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.
 
 
If questions (5) or (6) are answered “Yes,” the loan will not be approved. 
Question 
Yes 
No 
5.
Is the Applicant (if an individual) or any individual owning 20% or more of the equity of the Applicant subject
to an indictment, criminal information, arraignment, or other means by which formal criminal charges are
brought in any jurisdiction, or presently incarcerated, or on probation or parole?
Initial here to confirm your response to question 5 →
6.
Within the last 5 years, for any felony, has the Applicant (if an individual) or any owner of the Applicant 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 →
7.
Is the United States the principal place of residence for all employees of the Applicant included in the
Applicant’s payroll calculation above?
8.
Is the Applicant a franchise that is listed in the SBA’s Franchise Directory?
OMB Control No.: 3245-0407  
Expiration Date: 09/30/2020
206  938-4291
Eric Shibley
shibley98271@gmail.com
94,000
6
4700 36th Ave SW Seattle WA 98126
37,600
Eric R Shibley
Manager
100
-5264
4700 36th Ave SW Seattle WA 98126
ers
ers
3580
SFC LLC
FOIA CONFIDENTIAL TREATMENT REQUESTED
ATH-RC_0000428
DOJ-01-0000003395
U.S. v. Shibley 
CR20-174 JCC 
Government Exhibit No. 14 
Admitted ________________
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Paycheck Protection Program 
Borrower Application Form 
 
2 
SBA Form 2483 (04/20) 
 
By Signing Below, You Make the Following Representations, Authorizations, and Certifications 
CERTIFICATIONS AND AUTHORIZATIONS 
I certify that: 
 
I have read the statements included in this form, including the Statements Required by Law and Executive Orders, and I understand them. 
 
The Applicant is eligible to receive a loan under the rules in effect at the time this application is submitted that have been issued by the 
Small Business Administration (SBA) implementing the Paycheck Protection Program under Division A, Title I of the Coronavirus 
Aid, Relief, and Economic Security Act (CARES Act) (the Paycheck Protection Program Rule).  
 
The Applicant (1) is an independent contractor, eligible self-employed individual, or sole proprietor or (2) employs no more 
than the greater of 500 or employees or, if applicable, the size standard in number of employees established by the SBA in 13 
C.F.R. 121.201 for the Applicant’s industry. 
 
I 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 and consistent with the 
Paycheck Protection Program Rule. 
 
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.  
 
Any loan received by the Applicant under Section 7(b)(2) of the Small Business Act between January 31, 2020 and April 3, 2020 was 
for a purpose other than paying payroll costs and other allowable uses loans under the Paycheck Protection Program Rule. 
 
For Applicants who are individuals:  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 authorized representative of the Applicant must certify in good faith to all of the below by initialing next to each one:  
 
_____  
The Applicant was in operation on February 15, 2020 and had employees for whom it paid salaries and payroll taxes or paid independent 
contractors, as reported on Form(s) 1099-MISC. 
_____  
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 interest payments, lease payments, and utility payments, 
as specified under the Paycheck Protection Program Rule; I understand that if the funds are knowingly used for unauthorized purposes, 
the federal government may hold me legally liable, such as for charges of fraud. 
_____ 
The Applicant will provide to the Lender documentation verifying the number of full-time equivalent employees on the Applicant’s 
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.   
_____ 
I understand that loan forgiveness will be provided for the sum of documented payroll costs, covered mortgage interest payments, 
covered rent payments, and covered utilities, and not more than 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 the Paycheck Protection Program. 
_____ 
I further certify that the information provided in this application and the information provided in all supporting documents and 
forms is true and accurate in all material respects. I understand that knowingly making a false statement to obtain a guaranteed loan 
from SBA is punishable under the law, including 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 confirm the eligible loan amount using required documents submitted. I understand, 
acknowledge and agree that the Lender can share any tax information that I have provided with SBA's authorized representatives, 
including authorized representatives of the SBA Office of Inspector General, for the purpose of compliance with SBA Loan 
Program Requirements and all SBA reviews. 
_________________________________________________________   
________________________ 
Signature of Authorized Representative of Applicant 
Date 
 
Print Name 
 
 
 
 
 
 
 
            Title 
red
ers
ers
ers
ers
ers
ers
ers
04/25/2020
Manager
Eric R Shibley
FOIA CONFIDENTIAL TREATMENT REQUESTED
ATH-RC_0000429
DOJ-01-0000003396
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Paycheck Protection Program 
Borrower Application Form 
 
3 
SBA Form 2483 (04/20) 
 
Purpose of this form: 
 
This form is to be completed by the authorized representative of the Applicant 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: 
 
With respect to “purpose of the loan,” payroll costs consist of compensation to employees (whose principal place of residence is the United 
States) in the form of salary, wages, commissions, or similar compensation; cash tips or the equivalent (based on employer records of past tips 
or, in the absence of such records, a reasonable, good-faith employer estimate of such tips); payment for vacation, parental, family, medical, or 
sick leave; allowance for separation or dismissal; payment for the provision of employee benefits consisting of group health care coverage, 
including insurance premiums, and retirement; payment of state and local taxes assessed on compensation of employees; and for an 
independent contractor or sole proprietor, wage, commissions, income, or net earnings from self-employment or similar compensation.   
 
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.  
 
If Applicant is refinancing an Economic Injury Disaster Loan (EIDL): Add the outstanding amount of an EIDL made between January 31, 2020 
and April 3, 2020, less the amount of any “advance” under an EIDL COVID-19 loan, to Loan Request as indicated on the form. 
 
All parties listed below are considered owners of the Applicant as defined in 13 CFR § 120.10, as well as “principals”: 
 For a sole proprietorship, the sole  proprietor; 
 For a partnership, all general partners, and all limited partners owning 20% or more of the equity of the firm; 
 For a corporation, all owners of 20% or more of the corporation; 
 For limited liability companies, all members owning 20% or more of the company; and 
 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 
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Paycheck Protection Program 
Borrower Application Form 
 
4 
SBA Form 2483 (04/20) 
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. 
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 the Applicant or any owner of the Applicant 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. 
 
FOIA CONFIDENTIAL TREATMENT REQUESTED
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Page 2 of 4
NOTE TERMS:  
Maturity:  This Note will mature 2 years from date of Note.  
Repayment Terms:  
The interest rate is 1.0% per year. The interest rate may only be changed in accordance with SOP 50 10, the 
CARES Act, or guidance established by the SBA or U.S. Treasury.    
Payments of the Loan shall be deferred for the first six (6) months following disbursement of the Loan.  
Borrower must pay principal and interest payments every month, beginning seven (7) months following the 
date of the Note; payments must be made on the same day as the date of the Note in the months they are due.  
Interest shall continue to accrue during the six (6) month deferment.  
Lender will apply each installment payment first to pay interest accrued to the day Lender receives the 
payment, then to bring principal current and will apply any remaining balance to reduce principal.  
This Loan is made under the provisions of the PPP, 7(a) Loan Program and the CARES Act.  The principal 
under this Note may be reduced or forgiven in accordance with the loan forgiveness provisions of the CARES 
Act and regulations or requirements established by SBA and the U.S. Treasury.  The principal of this Note 
is not be deemed forgiven or reduced until documented in a writing, signed by Lender or the SBA. Interest 
under this loan will not be forgiven but payments for interest may be made by SBA.   
Lender shall notify Borrower of its determination of debt forgiveness and of any remaining balance which  
bWP[[ R^]cX]dT c^ QT SdT P]S ^fX]V d]STa cWT E^cT &cWT jHT\PX]X]V FQ[XVPcX^]bk'* 9^aa^fTa \dbc _Ph _aX]RX_P[
and interest payments on the Remaining Obligations, in an amount calculated by the Lender, which will amortize 
the Remaining Obligations, plus interest, amortized over the remaining eighteen (18) months of this Note.  
Principal and interest payments on the Remaining Obligations shall begin on the date which is seven (7) months 
from the date of this Note and shall continue on the same date of each of the seventeen  
(17) consecutive months thereafter.  BORROWER AGREES THAT THE MONTHLY PRINCIPAL AND 
INTEREST PAYMENTS PROVIDED BY LENDER TO BORROWER TO SATISFY THE REMAINING 
OBLIGATIONS SHALL BE BINDING UPON THE BORROWER AND GIVEN THE SAME LEGAL 
EFFECT AS IF THE SPECIFIC AMOUNT OF THE PRINCIPAL AND INTEREST PAYMENTS WERE 
SET FORTH IN THIS NOTE. 
Loan Prepayment: 
No prepayment fee will be due under the terms of this Note.    
All remaining principal and accrued interest is due and payable 2 years from date of Note.  
4.
DEFAULT:  
Borrower is in default under this Note if Borrower does not make a payment when due under this Note, or if Borrower:  
A.
Fails to do anything required by this Note;  
B.
Defaults on any other loan with Lender;  
C.
Does not disclose, or anyone acting on their behalf does not disclose, any material fact to Lender or  
SBA;  
D.
Makes, or anyone acting on their behalf makes, a materially false or misleading representation to  
Lender or SBA;  
E.
Defaults on any loan or agreement with another creditor, if Lender believes the default may materially 
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F.
Fails to pay any taxes when due;  
G.
Becomes the subject of a proceeding under any bankruptcy or insolvency law;  
H.
Has a receiver or liquidator appointed for any part of their business or property;  
I.
Makes an assignment for the benefit of creditors;  
J.
Has any adverse change in financial condition or business operation that Lender believes may  materially 
affect BorrowTalb PQX[Xch c^ _Ph cWXb E^cT7
K.
Reorganizes, merges, consolidates, or otherwise changes ownership or business structure without  
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L.
Becomes the subject of a civil or criminal action that Lender believes may materially afUTRc 9^aa^fTalb
ability to pay this Note.  
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Page 3 of 4
5.
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Without notice or demand and without giving up any of its rights, Lender may: A.  
Require immediate payment of all amounts owing under this Note;  
B.
Collect all amounts owing from Borrower;  
C.
File suit and obtain judgment;  
6.
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A.
Incur expenses to collect amounts due under this Note, enforce the terms of this Note or any other Loan 
Document.  If Lender incurs such expenses, it may demand immediate  repayment from Borrower or add 
the expenses to the principal balance;  
B.
Release anyone obligated to pay this Note;  
7.
WHEN FEDERAL LAW APPLIES:  
When SBA is the holder, this Note will be interpreted and enforced under federal law, including SBA regulations. 
Lender or SBA may use state or local procedures for filing papers, recording documents, giving notice, and other 
purposes.  By using such procedures, SBA does not waive any federal immunity from state or local control, penalty, 
tax, or liability.  As to this Note, Borrower may not claim or assert against SBA any local or state law to deny any 
obligation, defeat any claim of SBA, or preempt federal law.  
8.
SUCCESSORS AND ASSIGNS:  
Under this Note, Borrower includes the successors of Borrower, and Lender includes its successors and assigns.  
9.
GENERAL PROVISIONS:  
A.
All individuals and entities signing this Note are jointly and severally liable.  
B.
Borrower waives all suretyship defenses.  
C.
Lender may exercise any of its rights separately or together, as many times and in any order it chooses.   
Lender may delay or forgo enforcing any of its rights without giving up any of them.  
D.
Borrower may not use an oral statement of Lender or SBA to contradict or alter the written terms of this  
Note.  
E.
If any part of this Note is unenforceable, all other parts remain in effect.  
F.
To the extent allowed by law, Borrower waives all demands and notices in connection with this Note, 
including presentment, demand, protest, and notice of dishonor.  Borrower also waives any defenses based 
upon any claim that Lender did not obtain any guarantee.    
10. DISCLOSURES  
A.
This Loan is made under the terms and conditions of the PPP and SBA 7(a) Loan Program and shall be 
subject to current and future regulations, guidance, statutory provisions or rules governing the PPP or 
SBA 7(a) Loan Programs.   
B.
Forgiveness of principal under this Loan may only granted in accordance with the PPP and the CARES 
Act, Lender has made no promise, guarantee, or representation to Borrower regarding forgiveness of the 
principal or accrued interest under this Loan and Borrower may not rely on any statement or representation 
from Lender with respect to loan forgiveness. Borrower understands that forgiveness is only available for 
principal that is used of the limited purposes that qualify for forgiveness under SBA requirements.   
C.
The Paycheck Protection Program Borrower Application Form (SBA Form 2483) contains certain 
statements, including the Statements Required by Law and Executive Orders and the Debarment and 
Suspension Executive Order and by executing below the Borrower is confirming to have read and 
understood the statements included in the Application Form.   
D.
Borrower understands and acknowledges that not more than 25% of the amount forgiven can be  
attributable to non-payroll costs.     
E.
Borrower understands and agrees that forgiveness is not automatic and Borrower must request it.   
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Page 4 of 4
11. CERTIFICATIONS  
By signing below, Borrower certifies, represents, warrants, and agrees:   
A.
All certifications, authorizations, and representations made by Borrower and/or the authorized 
representative of Borrower in the Paycheck Protection Program Borrower Application Form (SBA Form 
2483) submitted to Lender remain true and accurate as of the date of this Note.   
B.
The proceeds of such Loan are intended to be used for payroll costs; costs related to the continuation of 
group health care benefits during periods of paid sick, medical, or family leave, and insurance premiums; 
employee salaries, commissions, or similar compensations; payments of interest on mortgage obligations 
(which shall not include any prepayment of or payment of principal on a mortgage obligation); rent 
(including rent under a lease agreement); utilities; interest on any other debt obligations that were incurred 
before February 15, 2020, and as otherwise permitted under the CARES Act, as amended and/or modified.
C.  No parts of the proceeds of such Loan will be used for personal, family or household purposes.  
D.
The undersigned is exercising and will continue to exercise actual control over the managerial decisions 
of the Borrower concerning the use of funds and/or credit to be derived from the Loan.  
E.
The undersigned hereby agrees to promptly correct any defect, error or omission, or provide any 
documentation requested or required, upon request of Lender or SBA, which may be discovered in the 
contents of any loan documentation, the application or in the execution or acknowledgment thereof, and 
will execute, or re-execute, acknowledge and deliver such further instruments and do such further acts as 
may be necessary or reasonably requested by Lender to satisfy the terms and conditions of this Loan,  
and/or the requirements of PPP, SBA, or Treasury, as applicable.  
F.
The execution of this NotT P]S P]h aT[PcTS [^P] S^Rd\T]cb _aX^a c^ R^\_[TcX^] ^U P[[ ^U CT]STalb
conditions may be permitted as an accommodation to Borrower.  Lender shall not be obligated to fund 
the Loan until Lender receives and satisfies all of its loan conditions and requirements under applicable 
rule or law and receives all documents it deems necessary, including but not limited to the satisfactory 
evidence and documentation of payroll costs supporting the requested Loan and any forms to be 
completed by Lender, including SBA Form 2484.  
G.
If the Borrower is an entity, the undersigned is authorized and empowered to execute and deliver this 
Note to Lender, any required corporate or company action necessary to authorize the Loan has been duly 
completed or performed, and the actions taken herein are hereby ratified and confirmed.    
12. STATE-SPECIFIC PROVISIONS:  
13. 9FHHFM<HlI E8D<&I' 8E; I@>E8JKH<&I'6
By signing below, each individual or entity becomes obligated under this Note as Borrower.  
BORROWER: 
_______________________ 
By:___________________________________  
____________, ______________  
1<6>598;"2;?7:<=7"41."'&+-3$3/#&(3(#(,)*#,&',#/)3%(30(%&3/
SFC LLC
Eric Shibley
Manager
FOIA CONFIDENTIAL TREATMENT REQUESTED
ATH-RC_0000410
DOJ-01-0000003381
Case 2:20-cr-00174-JCC     Document 137-5     Filed 11/26/21     Page 13 of 34

FOIA CONFIDENTIAL TREATMENT REQUESTED
ATH-RC_0000411
DOJ-01-0000003382
Case 2:20-cr-00174-JCC     Document 137-5     Filed 11/26/21     Page 14 of 34

1<6>598;"2;?7:<=7"41."'&+-3$3/#&(3(#(,)*#,&',#/)3%(30(%&3/
FOIA CONFIDENTIAL TREATMENT REQUESTED
ATH-RC_0000412
DOJ-01-0000003383
Case 2:20-cr-00174-JCC     Document 137-5     Filed 11/26/21     Page 15 of 34

Certificate Of Completion
Envelope Id: 3279F0FA24F448568238A5F14FC412FA
Status: Completed
Subject: Eric Shibley, Please DocuSign the SBA Note and ACH
Source Envelope: 
Document Pages: 6
Signatures: 2
Envelope Originator: 
Certificate Pages: 4
Initials: 0
Bryan Bacallao
AutoNav: Enabled
EnvelopeId Stamping: Enabled
Time Zone: (UTC-05:00) Eastern Time (US & Canada)
200 Connell Drive, Suite 4000
Berkeley Heights, NJ  07922
bryan.bacallao@knightcapitalfunding.com
IP Address: 13.110.14.8    
Record Tracking
Status: Original
             6/2/2020 4:08:52 PM
Holder: Bryan Bacallao
             bryan.bacallao@knightcapitalfunding.com
Location: DocuSign
Signer Events
Signature
Timestamp
Eric Shibley
shibley98271@gmail.com
Manager
Security Level: Email, Account Authentication 
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 73.109.30.232
Sent: 6/2/2020 4:09:33 PM
Viewed: 6/2/2020 4:11:21 PM 
Signed: 6/2/2020 7:09:27 PM
Electronic Record and Signature Disclosure: 
      Accepted: 6/2/2020 4:11:21 PM
      ID: 0e5f5209-2925-4aac-b6be-8eebdff595e1
      Company Name: ReadyCap Lending, LLC
In Person Signer Events
Signature
Timestamp
Editor Delivery Events
Status
Timestamp
Agent Delivery Events
Status
Timestamp
Intermediary Delivery Events
Status
Timestamp
Certified Delivery Events
Status
Timestamp
Carbon Copy Events
Status
Timestamp
Witness Events
Signature
Timestamp
Notary Events
Signature
Timestamp
Envelope Summary Events
Status
Timestamps
Envelope Sent
Hashed/Encrypted
6/2/2020 4:09:33 PM
Certified Delivered
Security Checked
6/2/2020 4:11:22 PM
Signing Complete
Security Checked
6/2/2020 7:09:27 PM
Completed
Security Checked
6/2/2020 7:09:27 PM
Payment Events
Status
Timestamps
Electronic Record and Signature Disclosure
FOIA CONFIDENTIAL TREATMENT REQUESTED
ATH-RC_0000316
DOJ-01-0000003293
Case 2:20-cr-00174-JCC     Document 137-5     Filed 11/26/21     Page 16 of 34

ELECTRONIC RECORD AND SIGNATURE DISCLOSURE
From time to time, ReadyCap Lending, LLC (we, us or Company) may be required by law to 
provide to you certain written notices or disclosures. Described below are the terms and 
conditions for providing to you such notices and disclosures electronically through the 
DocuSign, Inc. (DocuSign) electronic signing system. Please read the information below 
carefully and thoroughly, and if you can access this information electronically to your 
satisfaction and agree to these terms and conditions, please confirm your agreement by clicking 
\PM e; IOZMMf J]\\WV I\ \PM JW\\WU WN \PQ[ LWK]UMV\*
Getting paper copies
At any time, you may request from us a paper copy of any record provided or made available 
electronically to you by us. You will have the ability to download and print documents we send 
to you through the DocuSign system during and immediately after signing session and, if you 
elect to create a DocuSign signer account, you may access them for a limited period of time 
(usually 30 days) after such documents are first sent to you. After such time, if you wish for us to 
send you paper copies of any such documents from our office to you, you will be charged a 
$0.00 per-page fee. You may request delivery of such paper copies from us by following the 
procedure described below.  
Withdrawing your consent 
If you decide to receive notices and disclosures from us electronically, you may at any time 
change your mind and tell us that thereafter you want to receive required notices and disclosures 
only in paper format. How you must inform us of your decision to receive future notices and 
disclosure in paper format and withdraw your consent to receive notices and disclosures 
electronically is described below.  
Consequences of changing your mind
If you elect to receive required notices and disclosures only in paper format, it will slow the 
speed at which we can complete certain steps in transactions with you and delivering services to 
you because we will need first to send the required notices or disclosures to you in paper format, 
and then wait until we receive back from you your acknowledgment of your receipt of such 
paper notices or disclosures. To indicate to us that you are changing your mind, you must 
_Q\PLZI_ aW]Z KWV[MV\ ][QVO \PM 6WK]BQOV eFQ\PLZI_ 5WV[MV\f NWZU WV \PM [igning page of a 
DocuSign envelope instead of signing it. This will indicate to us that you have withdrawn your 
consent to receive required notices and disclosures electronically from us and you will no longer 
be able to use the DocuSign system to receive required notices and consents electronically from 
us or to sign electronically documents from us.  
All notices and disclosures will be sent to you electronically
Unless you tell us otherwise in accordance with the procedures described herein, we will provide 
electronically to you through the DocuSign system all required notices, disclosures, 
authorizations, acknowledgements, and other documents that are required to be provided or made 
available to you during the course of our relationship with you. To reduce the chance of you 
inadvertently not receiving any notice or disclosure, we prefer to provide all of the required 
notices and disclosures to you by the same method and to the same address that you have given 
us. Thus, you can receive all the disclosures and notices electronically or in paper format through 
the paper mail delivery system. If you do not agree with this process, please let us know as 
described below. Please also see the paragraph immediately above that describes the 
consequences of your electing not to receive delivery of the notices and disclosures 
electronically from us.  
,953><;:83"/53;<4"1:4"086:1>?<5"+8=39;=?<5"3<51>54";:*"(#'$#&$&$"'*&$*%)".-
.1<>85="16<554">;*",<83"078295@
FOIA CONFIDENTIAL TREATMENT REQUESTED
ATH-RC_0000317
DOJ-01-0000003294
Case 2:20-cr-00174-JCC     Document 137-5     Filed 11/26/21     Page 17 of 34

How to contact ReadyCap Lending, LLC:
You may contact us to let us know of your changes as to how we may contact you electronically, 
to request paper copies of certain information from us, and to withdraw your prior consent to 
receive notices and disclosures electronically as follows: 
To contact us by email send messages to: raymond.cantwell@rclending.com 
To advise ReadyCap Lending, LLC of your new e-mail address 
To let us know of a change in your e-mail address where we should send notices and disclosures 
electronically to you, you must send an email message to us at 
raymond.cantwell@rclending.com and in the body of such request you must state: your previous 
e-mail address, your new e-mail address.  We do not require any other information from you to 
change your email address..   
In addition, you must notify DocuSign, Inc. to arrange for your new email address to be reflected 
in your DocuSign account by following the process for changing e-mail in the DocuSign system.  
To request paper copies from ReadyCap Lending, LLC
To request delivery from us of paper copies of the notices and disclosures previously provided 
by us to you electronically, you must send us an e-mail to raymond.cantwell@rclending.com and 
in the body of such request you must state your e-mail address, full name, US Postal address, and 
telephone number. We will bill you for any fees at that time, if any.  
To withdraw your consent with ReadyCap Lending, LLC
To inform us that you no longer want to receive future notices and disclosures in electronic 
format you may: 
i. decline to sign a document from within your DocuSign session, and on the subsequent 
page, select the check-box indicating you wish to withdraw your consent, or you may; 
ii. send us an e-mail to raymond.cantwell@rclending.com and in the body of such request 
you must state your e-mail, full name, US Postal Address, and telephone number. We do 
not need any other information from you to withdraw consent..  The consequences of 
your withdrawing consent for online documents will be that transactions may take a 
longer time to process..  
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Operating 
Systems: 
Windows® 2000, Windows® XP, Windows Vista®; Mac OS® X 
Browsers: 
Final release versions of Internet Explorer® 6.0 or above (Windows only); 
=WbQTTI 8QZMNW` ,*+ WZ IJW^M %FQVLW_[ IVL =IK&1 BINIZQd -*+ WZ IJW^M
(Mac only) 
PDF Reader: 
Acrobat® or similar software may be required to view and print PDF files 
FOIA CONFIDENTIAL TREATMENT REQUESTED
ATH-RC_0000318
DOJ-01-0000003295
Case 2:20-cr-00174-JCC     Document 137-5     Filed 11/26/21     Page 18 of 34

Screen 
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** These minimum requirements are subject to change. If these requirements change, you will be 
asked to re-accept the disclosure. Pre-release (e.g. beta) versions of operating systems and 
browsers are not supported.  
Acknowledging your access and consent to receive materials electronically
To confirm to us that you can access this information electronically, which will be similar to 
other electronic notices and disclosures that we will provide to you, please verify that you were 
able to read this electronic disclosure and that you also were able to print on paper or 
electronically save this page for your future reference and access or that you were able to e-mail 
this disclosure and consent to an address where you will be able to print on paper or save it for 
your future reference and access. Further, if you consent to receiving notices and disclosures 
exclusively in electronic format on the terms and conditions described above, please let us know 
Ja KTQKSQVO \PM e; IOZMMf J]\\WV JMTW_*
4a KPMKSQVO \PM e; IOZMMf JW`( ; KWVNQZU \PI\0
|
I can access and read this Electronic CONSENT TO ELECTRONIC RECEIPT OF 
ELECTRONIC RECORD AND SIGNATURE DISCLOSURES document; and 
|
I can print on paper the disclosure or save or send the disclosure to a place where I can 
print it, for future reference and access; and 
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Until or unless I notify ReadyCap Lending, LLC as described above, I consent to receive 
from exclusively through electronic means all notices, disclosures, authorizations, 
acknowledgements, and other documents that are required to be provided or made 
available to me by  ReadyCap Lending, LLC during the course of my relationship with 
you. 
FOIA CONFIDENTIAL TREATMENT REQUESTED
ATH-RC_0000319
DOJ-01-0000003296
Case 2:20-cr-00174-JCC     Document 137-5     Filed 11/26/21     Page 19 of 34

Paycheck Protection Program 
Borrower Application Form 
1 
SBA Form 2483 (04/20) 
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Check One: 
‰ Sole proprietor   ‰ Partnership   ‰ C-Corp   ‰ S-Corp   ‰ LLC
‰ Independent contractor  ‰ Eligible self-employed individual
‰ 501(c)(3) nonprofit   ‰ 501(c)(19) veterans organization
‰ Tribal business (sec. 31(b)(2)(C) of Small Business Act)   ‰ Other
DBA or Tradename if Applicable 
Business Legal Name 
Business Address 
Business TIN (EIN, SSN) 
Business Phone 
(     )        - 
Primary Contact 
Email Address 
Average Monthly Payroll: 
$ 
 x 2.5 + EIDL, Net of 
Advance (if Applicable) 
Equals Loan Request: 
$ 
Number of Employees:  
Purpose of the loan 
  (select more than one): 
܆Payroll  տLease / Mortgage Interest   տUtilities   տOther (explain):__________________
Applicant Ownership 
List all owners of 20% or more of the equity of the Applicant. 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 Applicant or any owner of the Applicant 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 Applicant, any owner of the Applicant, 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 Applicant or any owner of the Applicant an owner of any other business, or have common management with, any other
business? If yes, list all such businesses and describe the relationship on a separate sheet identified as addendum A.
4.
Has the Applicant 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.
 
If questions (5) or (6) are answered “Yes,” the loan will not be approved. 
Question
Yes 
No 
5.
Is the Applicant (if an individual) or any individual owning 20% or more of the equity of the Applicant subject
to an indictment, criminal information, arraignment, or other means by which formal criminal charges are
brought in any jurisdiction, or presently incarcerated, or on probation or parole?
Initial here to confirm your response to question 5 ĺ    
6.
Within the last 5 years, for any felony, has the Applicant (if an individual) or any owner of the Applicant 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.
Is the United States the principal place of residence for all employees of the Applicant included in the
Applicant’s payroll calculation above?
8.
Is the Applicant a franchise that is listed in the SBA’s Franchise Directory?
OMB Control No.: 3245-0407  
Expiration Date: 09/30/2020
■
Eric R Shibley MD PLLC
4700 36th Ave SW
9052
2069384291
Eric SHibley
shibleymedical@outlook.com
40000
100000
5
■
■
■
■
employee benefits
Eric R Shibley
Manager
100
5264700 36th Ave SW Seattle W
■
■
■
■
■
ers
ers
■
■
U.S. v. Shibley 
CR20-174 JCC 
Government Exhibit No. 15 
Admitted ________________
Case 2:20-cr-00174-JCC     Document 137-5     Filed 11/26/21     Page 20 of 34

Paycheck Protection Program 
Borrower Application Form 
 
2 
SBA Form 2483 (04/20) 
 
By Signing Below, You Make the Following Representations, Authorizations, and Certifications 
CERTIFICATIONS AND AUTHORIZATIONS 
I certify that: 
x
I have read the statements included in this form, including the Statements Required by Law and Executive Orders, and I understand them. 
x
The Applicant is eligible to receive a loan under the rules in effect at the time this application is submitted that have been issued by the 
Small Business Administration (SBA) implementing the Paycheck Protection Program under Division A, Title I of the Coronavirus 
Aid, Relief, and Economic Security Act (CARES Act) (the Paycheck Protection Program Rule).  
x
The Applicant (1) is an independent contractor, eligible self-employed individual, or sole proprietor or (2) employs no more 
than the greater of 500 or employees or, if applicable, the size standard in number of employees established by the SBA in 13 
C.F.R. 121.201 for the Applicant’s industry. 
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 and consistent with the 
Paycheck Protection Program Rule. 
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.  
x
Any loan received by the Applicant under Section 7(b)(2) of the Small Business Act between January 31, 2020 and April 3, 2020 was 
for a purpose other than paying payroll costs and other allowable uses loans under the Paycheck Protection Program Rule. 
 
For Applicants who are individuals:  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 authorized representative of the Applicant must certify in good faith to all of the below by initialing next to each one:  
 
_____  
The Applicant was in operation on February 15, 2020 and had employees for whom it paid salaries and payroll taxes or paid independent 
contractors, as reported on Form(s) 1099-MISC. 
_____  
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 interest payments, lease payments, and utility payments, 
as specified under the Paycheck Protection Program Rule; I understand that if the funds are knowingly used for unauthorized purposes, 
the federal government may hold me legally liable, such as for charges of fraud. 
_____ 
The Applicant will provide to the Lender documentation verifying the number of full-time equivalent employees on the Applicant’s 
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.   
_____ 
I understand that loan forgiveness will be provided for the sum of documented payroll costs, covered mortgage interest payments, 
covered rent payments, and covered utilities, and not more than 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 the Paycheck Protection Program. 
_____ 
I further certify that the information provided in this application and the information provided in all supporting documents and 
forms is true and accurate in all material respects. I understand that knowingly making a false statement to obtain a guaranteed loan 
from SBA is punishable under the law, including 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 confirm the eligible loan amount using required documents submitted. I understand, 
acknowledge and agree that the Lender can share any tax information that I have provided with SBA's authorized representatives, 
including authorized representatives of the SBA Office of Inspector General, for the purpose of compliance with SBA Loan 
Program Requirements and all SBA reviews. 
_________________________________________________________   
________________________ 
Signature of Authorized Representative of Applicant 
Date 
 
Print Name 
 
 
 
 
 
 
 
            Title 
ers
ers
ers
ers
ers
ers
ers
ers
Eric Ryan Shibley
Digitally signed by Eric Ryan Shibley 
Date: 2020.04.15 19:08:46 -07'00'
04/15/2020
Eric R Shibley
04/15/2020
Case 2:20-cr-00174-JCC     Document 137-5     Filed 11/26/21     Page 21 of 34

Paycheck Protection Program 
Borrower Application Form 
 
3 
SBA Form 2483 (04/20) 
 
Purpose of this form: 
 
This form is to be completed by the authorized representative of the Applicant 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: 
 
With respect to “purpose of the loan,” payroll costs consist of compensation to employees (whose principal place of residence is the United 
States) in the form of salary, wages, commissions, or similar compensation; cash tips or the equivalent (based on employer records of past tips 
or, in the absence of such records, a reasonable, good-faith employer estimate of such tips); payment for vacation, parental, family, medical, or 
sick leave; allowance for separation or dismissal; payment for the provision of employee benefits consisting of group health care coverage, 
including insurance premiums, and retirement; payment of state and local taxes assessed on compensation of employees; and for an 
independent contractor or sole proprietor, wage, commissions, income, or net earnings from self-employment or similar compensation.   
 
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.  
 
If Applicant is refinancing an Economic Injury Disaster Loan (EIDL): Add the outstanding amount of an EIDL made between January 31, 2020 
and April 3, 2020, less the amount of any “advance” under an EIDL COVID-19 loan, to Loan Request as indicated on the form. 
 
All parties listed below are considered owners of the Applicant 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 
Case 2:20-cr-00174-JCC     Document 137-5     Filed 11/26/21     Page 22 of 34

Paycheck Protection Program 
Borrower Application Form 
 
4 
SBA Form 2483 (04/20) 
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. 
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 the Applicant or any owner of the Applicant 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.
 
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DOJ-01-0000001539
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DOJ-01-0000001540
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Paycheck Protection Program 
Borrower Application Form 
1 
SBA Form 2483 (04/20) 
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Check One: 
‰ Sole proprietor   ‰ Partnership   ‰ C-Corp   ‰ S-Corp   ‰ LLC
‰ Independent contractor  ‰ Eligible self-employed individual
‰ 501(c)(3) nonprofit   ‰ 501(c)(19) veterans organization
‰ Tribal business (sec. 31(b)(2)(C) of Small Business Act)   ‰ Other
DBA or Tradename if Applicable 
Business Legal Name 
Business Address 
Business TIN (EIN, SSN) 
Business Phone 
(     )        - 
Primary Contact 
Email Address 
Average Monthly Payroll: 
$ 
 x 2.5 + EIDL, Net of 
Advance (if Applicable) 
Equals Loan Request: 
$ 
Number of Employees:  
Purpose of the loan 
  (select more than one): 
܆Payroll  տLease / Mortgage Interest   տUtilities   տOther (explain):__________________
Applicant Ownership 
List all owners of 20% or more of the equity of the Applicant. 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 Applicant or any owner of the Applicant 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 Applicant, any owner of the Applicant, 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 Applicant or any owner of the Applicant an owner of any other business, or have common management with, any other
business? If yes, list all such businesses and describe the relationship on a separate sheet identified as addendum A.
4.
Has the Applicant 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.
 
If questions (5) or (6) are answered “Yes,” the loan will not be approved. 
Question
Yes 
No 
5.
Is the Applicant (if an individual) or any individual owning 20% or more of the equity of the Applicant subject
to an indictment, criminal information, arraignment, or other means by which formal criminal charges are
brought in any jurisdiction, or presently incarcerated, or on probation or parole?
Initial here to confirm your response to question 5 ĺ    
6.
Within the last 5 years, for any felony, has the Applicant (if an individual) or any owner of the Applicant 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.
Is the United States the principal place of residence for all employees of the Applicant included in the
Applicant’s payroll calculation above?
8.
Is the Applicant a franchise that is listed in the SBA’s Franchise Directory?
OMB Control No.: 3245-0407  
Expiration Date: 09/30/2020
■
ES1 LLC
4700 36th Ave SW
5849
2069384291
Eric SHibley
ers98126@gmail.com
40000
100000
5
■
■
■
■
employee benefits
Eric R Shibley
Manager
100
-5264700 36th Ave SW Seattle W
■
■
■
■
■
ers
ers
■
■
U.S. v. Shibley 
CR20-174 JCC 
Government Exhibit No. 16 
Admitted ________________
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Paycheck Protection Program 
Borrower Application Form 
 
2 
SBA Form 2483 (04/20) 
 
By Signing Below, You Make the Following Representations, Authorizations, and Certifications 
CERTIFICATIONS AND AUTHORIZATIONS 
I certify that: 
x
I have read the statements included in this form, including the Statements Required by Law and Executive Orders, and I understand them. 
x
The Applicant is eligible to receive a loan under the rules in effect at the time this application is submitted that have been issued by the 
Small Business Administration (SBA) implementing the Paycheck Protection Program under Division A, Title I of the Coronavirus 
Aid, Relief, and Economic Security Act (CARES Act) (the Paycheck Protection Program Rule).  
x
The Applicant (1) is an independent contractor, eligible self-employed individual, or sole proprietor or (2) employs no more 
than the greater of 500 or employees or, if applicable, the size standard in number of employees established by the SBA in 13 
C.F.R. 121.201 for the Applicant’s industry. 
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 and consistent with the 
Paycheck Protection Program Rule. 
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.  
x
Any loan received by the Applicant under Section 7(b)(2) of the Small Business Act between January 31, 2020 and April 3, 2020 was 
for a purpose other than paying payroll costs and other allowable uses loans under the Paycheck Protection Program Rule. 
 
For Applicants who are individuals:  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 authorized representative of the Applicant must certify in good faith to all of the below by initialing next to each one:  
 
_____  
The Applicant was in operation on February 15, 2020 and had employees for whom it paid salaries and payroll taxes or paid independent 
contractors, as reported on Form(s) 1099-MISC. 
_____  
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 interest payments, lease payments, and utility payments, 
as specified under the Paycheck Protection Program Rule; I understand that if the funds are knowingly used for unauthorized purposes, 
the federal government may hold me legally liable, such as for charges of fraud. 
_____ 
The Applicant will provide to the Lender documentation verifying the number of full-time equivalent employees on the Applicant’s 
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.   
_____ 
I understand that loan forgiveness will be provided for the sum of documented payroll costs, covered mortgage interest payments, 
covered rent payments, and covered utilities, and not more than 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 the Paycheck Protection Program. 
_____ 
I further certify that the information provided in this application and the information provided in all supporting documents and 
forms is true and accurate in all material respects. I understand that knowingly making a false statement to obtain a guaranteed loan 
from SBA is punishable under the law, including 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 confirm the eligible loan amount using required documents submitted. I understand, 
acknowledge and agree that the Lender can share any tax information that I have provided with SBA's authorized representatives, 
including authorized representatives of the SBA Office of Inspector General, for the purpose of compliance with SBA Loan 
Program Requirements and all SBA reviews. 
_________________________________________________________   
________________________ 
Signature of Authorized Representative of Applicant 
Date 
 
Print Name 
 
 
 
 
 
 
 
            Title 
ers
ers
ers
ers
ers
ers
ers
ers
Eric Ryan Shibley
Digitally signed by Eric Ryan Shibley 
Date: 2020.04.15 19:08:46 -07'00'
04/15/2020
Eric R Shibley
04/15/2020
Case 2:20-cr-00174-JCC     Document 137-5     Filed 11/26/21     Page 28 of 34

Paycheck Protection Program 
Borrower Application Form 
 
3 
SBA Form 2483 (04/20) 
 
Purpose of this form: 
 
This form is to be completed by the authorized representative of the Applicant 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: 
 
With respect to “purpose of the loan,” payroll costs consist of compensation to employees (whose principal place of residence is the United 
States) in the form of salary, wages, commissions, or similar compensation; cash tips or the equivalent (based on employer records of past tips 
or, in the absence of such records, a reasonable, good-faith employer estimate of such tips); payment for vacation, parental, family, medical, or 
sick leave; allowance for separation or dismissal; payment for the provision of employee benefits consisting of group health care coverage, 
including insurance premiums, and retirement; payment of state and local taxes assessed on compensation of employees; and for an 
independent contractor or sole proprietor, wage, commissions, income, or net earnings from self-employment or similar compensation.   
 
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.  
 
If Applicant is refinancing an Economic Injury Disaster Loan (EIDL): Add the outstanding amount of an EIDL made between January 31, 2020 
and April 3, 2020, less the amount of any “advance” under an EIDL COVID-19 loan, to Loan Request as indicated on the form. 
 
All parties listed below are considered owners of the Applicant 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 
Case 2:20-cr-00174-JCC     Document 137-5     Filed 11/26/21     Page 29 of 34

Paycheck Protection Program 
Borrower Application Form 
 
4 
SBA Form 2483 (04/20) 
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. 
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 the Applicant or any owner of the Applicant 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.
 
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DOJ-01-0000001548
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DOJ-01-0000001558
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