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 | OMB No. | 3245-0185 | 
	
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 | Expiration Date: | XX/XX/2023 | 
	
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 | Guaranty Loan Status & Lender Remittance Form | 
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		| [     ] | Check box if lender information reflects changes | 
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 | F | [     ] | Check box if secondary market payment | 
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 | reported is a late payment or prepayment | 
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		| Lender's Name: | 
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 | Lender's Street Address: | 
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		| Lender's City, State, Zip: | 
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 | Lender's Contact Person: | 
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		| Contact Person's Telephone No.: | 
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 | Contact Person's Fax No: | 
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 | Month Ending: | 
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 | Next | 
 | Amt Disbursed | Amount | 
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 | Total to FTA | 
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 | Guar. Portion | Remittance | 
	
		| SBA | Lender | Installment | Status | this Period | Undisbursed | Interest | Guar. Portion | Guar. Portion | Guar. Portion | Interest Period | 
 | # of | Calendar | Closing | Penalty | 
	
		| GP Number | Loan Number | Due Date | (4 - 9) | on Total Loan | on Total Loan | Rate | Interest | Principal | Pymt or Fee | From | To | Days | Basis | Balance | (if any) | 
	
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 | Total: | 0.00 | 
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 | Total: | 0.00 | 
	
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 | Status Codes | 
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 | 4   Deferred | 7 | Transferred | 
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 | Grand Total: | 0.00 | 
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 | 5  In Liquidation | 8 | Purchased by SBA | 
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 | Total to FTA + Penalty | 
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 | 6  Paid-in-Full | 9 | Fully Undisbursed | 
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 | Check/Wire Amt: | 0.00 | 
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		| PLEASE NOTE: The estimated burden for completing this form is 1 hour per response. | 
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		| You are not required to respond to any collection of information unless it displays a currently valid OMB approval number. | 
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		| Comments on the burden should be sent to U.S. Small Business Administration, Chief, AIB, 409 3rd St., S.W., Washington D.C. 20416. | 
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		| And Desk Officer for the Small Business Adminstration, Office of Management and Budget, New Executive Office Building, Room 10202, Washington, D.C. 20503. | 
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		| OMB Approval (3245-0185). PLEASE DO NOT SEND FORMS TO OMB. | 
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