Form 1411 - Request For Allocation - Michigan Department Of Treasury

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Michigan Department of Treasury

Form 1411 (Rev. 01-12)

Request for Allocation

Issued under the authority of the Federal Deﬁ cit Reduction Act of 1984 and Excutive Order 1984-11 effective September 1, 1984.

You must ﬁ le this form to apply for allocation against the state ceiling.

Name of Issuer

County

Year in Which the Bond will be Issued

This request for allocation is a:

New Request

Amendment to Orginal Request

Previously Granted Request Extension Request

Amount in Excess of Obligation to be Refunded (if refund issue)

Total Principle Amount of Issue

Type of Facilty (attached description of the facility to be ﬁ nanced)

Owner of the Facility to be Financed (If known)

Principal Users of the Facility (if known)

Name of Law Firm Issuing Tax Exempt Opinion

Legal Counsel Name

Law Firm Address

Telephone Number

Yes

Has any previous request been made on behalf of the issuer for the issue? If yes, indicate year __________________________

Sequence Number ___________________________

Yes

Are these bonds to be sold at public sale? If yes, attach a copy of the proposed notice of sale.

Yes

Have all preliminary proceedings to the publication of the notice of sale been completed?

Yes

Are UDAG grants invovled in the transaction? Filing deadline: _____________________________________________________

Yes

Have TEFRA Hearings been held? If yes, indicate the date: ______________________________________________________

Yes

Are you required to get an allocation under current statutes?

Yes

Is this application for a housing bond?

Yes

Is this application for a Section 501(C)(3) bond?

Yes

Is this application for another type of bond? Specify: ___________________________________________

Yes

Will a portion of the bond proceeds be used to fund a debt service reserve? If yes, enter amount here: _____________________

and demonstrate that no reasonable alternative to assure debt service payment is available or desirable (Attach).

NOTE: You must attach a copy of an inducement resolution or other comparable preliminary approval AND a written commitment by an investor or

underwriter to purchase the bonds.

I hereby certify that the above information is correct and that I have not made or received any bribe, gift, gratuity or direct or indirect contribution to any

political campaign for consideration by the State Treasurer of the allocation request or of the issuer of a request to induce a project and seek allocation.

I understand that a change in the facility to be ﬁ nanced, in the issuer, in the year for which the allocation is sought or in the matters certiﬁ ed by the

issuer shall invalidate the request until an amended request is ﬁ led with the Department of Treasury and shall invalidate any allocation the extent of the

change.

Print Name

Print Title

Telephone Number

Signature

Date

Municipal Address

Sequence Number

Date Received

INTERNAL

USE ONLY

US Mail