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Home Court filings Allison Marie Baver case — U.S. District Court, D. Utah Exhibit 3: ABE’s 4/16/2020 Borrower Application Form to Northeast Bank — No. 2:21-cr-00520 (Dkt. 34-3, D. Utah)

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Exhibit 3: ABE’s 4/16/2020 Borrower Application Form to Northeast Bank — No. 2:21-cr-00520 (Dkt. 34-3, D. Utah)

Summary

Filed as Exhibit 3 (Dkt. 34-3) in No. 2:21-cr-00520 in the U.S. District Court for the District of Utah, this is the SBA Form 2483 Paycheck Protection Program borrower application that Allison Baver Entertainment, an LLC, submitted to Northeast Bank on April 16, 2020. The form lists average monthly payroll of $4,000,000, a loan request of $10,000,000 and 105 employees, with the loan sought for payroll and for other 'Entertainment Production Costs.' The electronic signature block names Allison Baver, Owner. An Addendum A lists High Rise Realty, LLC.

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One of 75 filings in No. 2:21-cr-00520.

Record facts

CourtU.S. District Court for the District of Utah

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“Exhibit 3: ABE’s 4/16/2020 Borrower Application Form to Northeast Bank — No. 2:21-cr-00520 (Dkt. 34-3, D. Utah).” U.S. District Court for the District of Utah, No. 2:21-cr-00520, Doc. 34-3. Archived at Pandemic Darlings, https://pandemicdarlings.com/court-filings/us-v-allison-marie-baver/undated-gov-uscourts-utd-129379-34-3-gov-uscourts-utd-129379-34-3/, SHA-256 4f4daf64f6ca976b6408092368af848d529778aeba12645cb800b18538b57a7e.

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Exhibit 3

ABE’s 4/16/2020 Borrower Application Form to Northeast Bank


Rae Paycheck Protection Program OMB Control No.: 3245-0407
ere Borrower Application Form Expiration Date: 09/30/2020

© Sole proprietor [_]|Partnership en [_Js-Corp [YJLLC [_]501(c)(3) nonprofit [Independent Contractor [ ]Other
| _J|Eligible self-employed individual 501(c)(19) veterans organization [_]Tribal business (sec. 31(b)(2)(C) of Small Business Act)

DBA or Tradename if applicable

Business Legal Name

Allison Baver Entertainment

Business Primary Address

Business TIN (EIN, SSN) Business Phone
i | |
Primary Contact Email Address
Allison Baver
Average Monthly x 2.5+EIDL, Net of Advance (if 3
Payroll: $4,000,000 Applicable) Equals Coan Requests $10,000,000 Number of Employees: | 105

[Y]Payroll [_]Lease / Mortgage Interest [_]Utilities [Y]Other (explain); Entertainment
Production Costs

Purpose of the loan (select more than one):

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

Jog!

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, i”
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 O
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 Oo
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, Cc
provide details on a separate sheet identified as addendum B.

If questions (5) ar (6) are answered "Yes", the loan will not be approved.

5. Is the Applicant (if an individual) or any individual owning 20% or more of the equity of the Applicant subject to an is
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 -> 0
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 -> as
7. Is the United States the principal place of residence for all employees of the Applicant included in the Applicant’s payroll] Cc
calculation above?
8. Is the Applicant a franchise that is listed in the SBA’s Franchise Directory? Oo

SBA Form 2483 (04/20)

FI-NEB-01-00031

Paycheck Protection Program
Borrower Application Form

ae

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

CERTIFICATIONS AND AUTHORIZATIONS

I certify-that:

e I have read the statements included in this form, including the Statements Required by Law and Executive Orders, and Lunderstand 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) itnplementing the:Paycheck Protection Program under Division.A, Title Lof the Coronavirus Aid,
Relief, and Economic Security Act (CARES Act) (the Paycheck Protection Program Rule).

e 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.

¢ [ will comply, whenever applicable, with the civil rights and other limitations in this form.

e 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, [will purchase only American-made equipment and products.

e The Applicant is not engaged in.any activity-thatis illegal under federal, state-or local law.

e 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; | 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.

L 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.

ais & RRR

L-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 Jaw, 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.

&

Lacknowledge that the lender will confirm the eligible loan amount using required documents submitted. | understand, acknowledge
and agree that the Lender.can share-any tax information that [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.

Won baer 4/16/2020

Signature. of Authorized Representative.of Applicant Date
65..130.210.80 /2020-04-16:01:3.1:49

Allison Baver Owner
Print Name Title

SBA Form 2483 (04/20)

FI-NEB-01-00032

Paycheck Protection Program
Borrower Application Form

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
premitims, and retirement; payment of state-and local taxes assessed-on compensation of employees; and for an indeperident 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. Forseasonal businesses, the-Applicant may elect to instead use average monthly payroll forthe
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 onan 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;

Fora: 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: Sivall 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 tight, benefit or privilege to which you are entitled, (But-see Debt Collection Notice
regarding taxpayer identification number below.) Disclosures-ofname and other personal identifiers are required te 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-reqléstor 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 1 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) susperid or debat you or your company from doing business. with the Federal Government, (5) refer-your loan-to
the Department of Justice, or (6) foreclose on-collateral or take other action permitted in the loan instruments.

Right to Financial Privacy Act of 1978 (12 U.S.C. 3401) — The Right to Financial Privacy Act of 1978, grants‘SBA access rights to financial
records:held by financial institutions that are or have-been doing business with you or your business including any financial institutions participating
in a loan or loan guaranty. SBA is only required provide a.certificate-of its. compliance with the Act-to a financial institution in connection with its
first request for access:to your financial records. SBA's access rights continue for the term of'any approved loan guaranty agreement, SBA is-also
authorized to transfer to another Government authority any financial records concerning an-approved loan or loan guarantee, as necessaty to process,
service or foreclose.on a loan guaranty or collect.on a defaulted loan guaranty.

SBA Form 2483 (04/20)

FI-NEB-01-00033

Paycheck Protection Program
Borrower Application Form

Freedom.of Information Act.(5 U.S.C, 552) ~ Subject to certain exceptions, SBA must-supply information reflectedin 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,
directots, 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:
(¢) indicted, convicted, or had a civil judgment rendered against you for any of the offenses listed inthe regulations or (d) delinquent on any-amounts
owed tothe U.S. Government or its instrumentalities as of the date of execution of this-certification,

SBA Form 2483 (04/20)

FI-NEB-01-00034

Paycheck Protection Program
Borrower Application Form

Addendum A
High Rise.Realty, LLC - Owner

Addendum A
SBA. Form 2483 (04/20)

FI-NEB-01-00035

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