Request For Cancellation Benefit Or Deferment Prior To Cancellation - State Of Illinois Page 2

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IV. Certification of Employment, Service, or Enlistment Period:
This space is
provided for the
organization's
Name of Specific School, Employer, Service Unit: _____________________________
official seal or
stamp. If one is not
Address: _____________________________________________________________
available, provide a
letter of
certification
City: _______________________ State: _______________ Zip: ________________
confirming the
borrower's service,
Telephone Number: (______)____________________
employment, or
enlistment. This
If borrower is a shortage teacher, please specify subject: ________________________
letter should
include employee's
start date and full-
I certify borrower is employed full-time. I further certify that the information provided
time status.
by the borrower regarding his/her service/employment is true and correct.
Signature of Official: ________________________________________________
Title: ____________________________________ Date: ___________________
For Internal Use Only
Deferred From:_______________ To:_____________ #Mos:______________ Grace Ending Date:______________________________
Processed by:___________________________________________________
Date:__________________________________________
Letter:
Cancelled at__________________% Code:__________________ End Date:____________________________
Fund_______________ Principal_______________ Interest________________ Balance__________________
Dates:
Fund_______________ Principal_______________ Interest________________ Balance__________________
Fund_______________ Principal_______________ Interest________________ Balance__________________
Fund_______________ Principal_______________ Interest________________ Balance__________________
Lending Institution Only:_________________________________________
__________________________
(Signature of Approving Official)
(Date)

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