Private Activity Bond Application For Statewide Balance - 2011

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1
2001 - PRIVATE ACTIVITY BOND APPLICATION FOR STATEWIDE BALANCE
1. ISSUING AUTHORITY
(name)
(address)
(issuing authority officer and title)
(telephone and fax)
2. PRIVATE BENEFICIARY OR PROPOSED PROJECT OR FINANCING
(name)
(address)
(principal company or entity contact)
(telephone and fax)
3. BOND COUNSEL FIRM
(name)
(address)
(individual responsible attorney)
(telephone and fax)
4. PROJECT OR FINANCING NAME
5. TYPE OF BONDS (check one below)
Manufacturing Activity
Single Family Mortgage
Multifamily Housing
Waste Treatment Facility
Waste Disposal
Water/Sewer
Other (Please Specify)
6. AMOUNT OF ALLOCATION BEING REQUESTED
To the best of my knowledge, this information and the attachments hereto are true and correct.
(issuing authority officer)
(date)

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