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Microloan Program Final Report Form - for Round One Recipients

  1. This form is for Small Business Emergency Microloan recipients of a City-funded microloan (Round One). Please complete this Final Report by no later than 11:59 p.m. on Friday, January 29, 2021.
  2. If you are a recipient of a CARES Act-funded microloan, please use the Round Two Final Report form available at
  3. If you have any questions about the form, or require assistance to complete the form, please contact Economic Development Staff by calling 925-833-6650 during business hours.
  4. (include “doing business as” if any)
  5. (Physical Location)
  6. (include part-time and full-time)
  7. Expenditure of Loan Funds
    Note: City of Dublin Small Business Emergency Microloan Funds are to be used only for payment of rent, mortgage, payroll or operating expenses, subject to the restrictions as set forth below, and incurred between March 1, 2020 and December 30, 2020 for business located at the address listed above.
  8. Were all loan funds spent by December 30, 2020? *
  9. Please specify how loan funds were spent
    Note: total should equal loan amount. Enter "0" if no loan funds were used for that purpose.
  10. Amount Spent
  11. Amount Spent
  12. Amount Spent
  13. Amount Spent
  14. Amount remaining, if any
  15. Terms and Conditions
    By checking each box below, Borrower affirms the following statements are true:
  16. Borrow affirms that:*
  17. Borrower affirms that loan funds were NOT used for: *
  18. Thank You
    Thank you for being part of the Dublin business community. If you have any questions about the Small Business Emergency Microloan Program, please reach out to the Office of Economic Development via email at or call 925-833-6650.
  19. Leave This Blank:

  20. This field is not part of the form submission.