FSA-2301 (03-23-15) Page 3 of 4
37. GENERAL INFORMATION
A. RIGHT TO FINANCIAL PRIVACY ACT OF 1978 (TITLE XI, 1113(h) OF PUB. L. 95-630): FSA has a right of access to financial records held
by financial institutions in connection with providing assistance to you, as well as collecting on loans made to you or guaranteed by the government.
Financial records involving your transaction will be available to FSA without further notice or authorization but will not be disclosed or released by
this institution to another government Agency or Department without your consent except as required by law.
B. THE FEDERAL EQUAL CREDIT OPPORTUNITY ACT prohibits creditors from discriminating against borrowers on the basis of race, color,
religion, sex, national origin, marital status, age (provided the borrower has the capacity to enter into a binding contract), because all or a part of the
borrower's income derives from any public assistance program, or because the borrower has in good faith exercised any right under the Consumer
Credit Protection Act.
38. CERTIFICATIONS
A. ABUSE OF CONTROLLED SUBSTANCES
I certify that as an individual, or as a member of an entity, I have not been convicted under Federal or State law of planting, cultivating, growing,
producing, harvesting, or storing a controlled substance within the previous 5 crop years. See the Food Security Act of 1985 (Pub. L. 99-198). I also
certify that as an individual, or as a member of an entity, I am not ineligible for Federal benefits based on a conviction for the distribution of
controlled substances or any offense involving the possession of a controlled substance under 21 U.S.C. § 862.
B. PERMISSION TO FILE A FINANCING STATEMENT
Under the Uniform Commercial Code, you do not have to sign the financing statement which allows FSA to obtain a security interest in your property.
If the loan is approved and funded, FSA will file a financing statement at the earliest possible date, before you enter into a SECURITY
AGREEMENT. BY SIGNING BELOW I GIVE FSA PERMISSION TO FILE A FINANCING STATEMENT PRIOR TO THE
EXECUTION OF THE SECURITY AGREEMENT AS WELL AS TO FILE AMENDMENTS AND CONTINUATIONS OF THE
FINANCING STATEMENT THEREAFTER.
C. FEDERAL COLLECTION POLICIES: Delinquencies, defaults, foreclosures and abuses of mortgage loans involving programs of the Federal
Government can be costly and detrimental to your credit, now and in the future. The mortgage lender in this transaction, its agents and assigns as well
as the Federal Government, its agencies, agents and assigns, are authorized to take any and all of the following actions in the event loan payments
become delinquent on the mortgaged loan described in the attached application: (1 ) Report your name and account information to a credit bureau,
(2) Assess additional interest and penalty charges for the period of time that payment is not made, (3) Assess charges to cover additional administrative
costs incurred by the Government to service your account, (4) Offset amounts owed to you under other Federal programs; (5) Refer your account to a
private attorney, collection agency or mortgage servicing agency to collect the amount due, foreclose the mortgage, sell the property and seek
judgment against you for any deficiency; (6) Refer your account to the Department of Justice for litigation; (7) If you are a current or retired Federal
employee, take action to offset your salary, or civil service retirement benefits; (8) Refer your debt to the Department of the Treasury for cross-
servicing and offset against any amount owed to you by any Federal Agency, such as an income tax refund; and (9) Report any resulting written-off
debt to the Internal Revenue Service as taxable income. All of these actions can and will be used to recover debts owed to the Federal Government,
when in its best interests.
40B. DATE
39. WARNING
I CERTIFY THAT THE INFORMATION PROVIDED IS TRUE, COMPLETE, AND CORRECT TO THE BEST OF MY KNOWLEDGE AND IS
PROVIDED IN GOOD FAITH TO OBTAIN A LOAN. (WARNING: SECTION 1001 OF TITLE 18, UNITED STATES CODE, PROVIDES FOR
CRIMINAL PENALTIES TO THOSE WHO PROVIDE FALSE STATEMENTS TO THE GOVERNMENT. IF ANY INFORMATION IS FOUND TO
BE FALSE OR INCOMPLETE, SUCH FINDING MAY BE GROUNDS FOR DENIAL OF THE REQUESTED ACTION.)
36. SPECIAL PROGRAM INFORMATION
Certain FSA programs are, by law, designed to reach targeted applicants. If you are interested in the program described below, or have questions about
this program and whether you may qualify for this program, the FSA office processing your application will help you.
SOCIALLY DISADVANTAGED APPLICANTS: A portion of FSA farm ownership and operating loan funds are, by law, targeted to applicants
who have been subjected to racial, ethnic or gender prejudice because of their identity as a member of a group, without regard to individual qualities.
Under the applicable law, groups meeting this condition are: American Indians/Alaskan Natives, Asians, Blacks/African Americans, Native
Hawaiians/Other Pacific Islanders, Hispanics, and Woman.
40A. SIGNATURE
C. DISQUALIFICATION DUE TO FEDERAL CROP INSURANCE FRAUD:
The applicant certifies that as an individual or any member of the entity, has not been disqualified for Federal benefits as provided in Section 515(h) of
the Federal Crop Insurance Act (FCIA). Applicants who willfully and intentionally provide false or inaccurate information to the Federal Crop
Insurance Corporation (FCIC) or to an approved insurance provider with respect to a policy or plan of FCIC insurance, after notice and an opportunity
for a hearing on the record, will be subject to one or more of the sanctions described in Section 515(h)(3) of FCIA.
D. RESTRICTIONS AND DISCLOSURE OF LOBBYING ACTIVITIES:
1. The loan applicant certifies that: if any funds, by or on behalf of the loan applicant, have been or will be paid to any persons for influencing or
attempting to influence an officer or employee of any agency, a Member, an officer or employee of Congress, or an employee of a Member of
Congress in connection with the awarding of any Federal contract, the making of any Federal grant or Federal loan, and the extension, continuation,
renewal, amendment, or modification of any Federal contract, grant or loan, the loan applicant shall complete and submit Standard Form - LLL,
"Disclosure of Lobbying Activities," in accordance with its instructions.
2. The loan applicant shall require that the language of this certification be included in the award documents for all sub-awards at all tiers (including
contracts, subcontracts, and subgrants, under grants and loans) and that all subrecipients shall certify and disclosure accordingly.
3. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of
this statement is a prerequisite for making or entering into this transaction imposed by 31 U.S.C. 1352. Any person who fails to file the required
statement shall be subject to a civil penalty,
