Schedule of Collateral Exhibit A (United States)
This is a Small Business Administration (SBA) schedule of collateral for a loan. The form provided here is simply a sample of what the actual form looks like.
U.S. SMALL BUSINESS ADMINISTRATION
OMB Approval No.: 3245-0016
Expiration Date: 06-30-99
SCHEDULE OF COLLATERAL
Exhibit A
Applicant ________________________
Street Address ________________________
City ________________________
State ________________________
Zip Code ________________________
LIST ALL COLLATERAL TO BE USED AS SECURITY FOR THIS LOAN
SECTION I - REAL ESTATE
Attach a copy of the deed(s) containing a full legal description of the land and show the location (street address) and city where the deed(s) is recorded. Following the address below, give a brief description of the improvements, such as size, type of construction, use, number of stories, and present condition (use additional sheet if more space is required).
LIST PARCELS OF REAL ESTATE
Address ________________________
Year Acquired ________________________
Original Cost ________________________
Market Value ________________________
Amount of Lien ________________________
Name of Lienholder ________________________
Description(s) ________________________
Address ________________________
Year Acquired ________________________
Original Cost ________________________
Market Value ________________________
Amount of Lien ________________________
Name of Lienholder ________________________
Description(s) ________________________
Address ________________________
Year Acquired ________________________
Original Cost ________________________
Market Value ________________________
Amount of Lien ________________________
Name of Lienholder ________________________
Description(s) ________________________
SECTION II - PERSONAL PROPERTY
All items listed herein must show manufacturer or make, model, year, and serial number. Items with no serial number must be clearly identified (use additional sheet if more space is required).
Description - Show Manufacturer, Model, Serial No.
________________________
Year Acquired ________________________
Original Cost ________________________
Market Value ________________________
Current Lien Balance ________________________
Name of Lienholder ________________________
Description - Show Manufacturer, Model, Serial No.
________________________
Year Acquired ________________________
Original Cost ________________________
Market Value ________________________
Current Lien Balance ________________________
Name of Lienholder ________________________
Description - Show Manufacturer, Model, Serial No.
________________________
Year Acquired ________________________
Original Cost ________________________
Market Value ________________________
Current Lien Balance ________________________
Name of Lienholder ________________________
All information contained herein is TRUE and CORRECT to the best of my knowledge. I understand that FALSE statements may result in forfeiture of benefits and possible fine and prosecution by the U.S. Attorney General (Ref. 18 U.S.C. 100).
PLEASE NOTE: The estimated burden for completing this form is 19.8 hours per response. You will not be required to respond to collection of information unless it displays a currently valid OMB approval number. Comments on the burden should be sent to U.S. Small Business Administration, Chief, AIB, 409 3rd St., S.W. Washington, D.C. 20416 and Desk Office for Small Business Administration, Office of Management and Budget, New Executive Office Building, Room 10202, Washington, D.C. 20503. OMB Approval (3245-0016).
________________________
Date ________________________
________________________
Date ________________________