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Form Me - Notice Of Claim Of Exemption From Registration For Certain Municipal Securities

Form ME (Rev. 07/06)

Colorado File No. ME

________________

Colorado Division of Securities

1560 Broadway St., Ste. 900

Denver, CO 80202

(303) 894-2320

Official use Only

COLORADO MUNICIPAL BOND SUPERVISION ACT

(TITLE 11, ARTICLE 59, C.R.S.)

NOTICE OF CLAIM OF EXEMPTION FROM REGISTRATION

FOR CERTAIN MUNICIPAL SECURITIES

Pursuant to the requirements of section 11-59-110 (2), C.R.S. notice of claim of exemption from the

registration requirements of the Colorado Municipal Bond Supervision Act is submitted to the Securities

Commissioner as follows:

1. ISSUE DESCRIPTION:

Name of Issue: _______________________________________________________________________

______________________________________________________________________

Amount of Issue: _________________ Dated (DTD): __/__/____ Final Maturity Date: _____________

Rating: Moody ____________/Standard & Poors ___________/Fitch _____________

Lead Underwriter/Placement Agent:______________________________________________________

2. TYPE OF DISTRICT:

_____ Special District;

_____ Municipal General Improvement District; _____ Municipal Special Improvement District;

_____ County Local Improvement District;

______ County Public Improvement District.

3. NAME, TITLE, FIRM, ADDRESS & PHONE NUMBER OF PERSON SUBMITTING NOTICE:

________________________________________________________

______________________________________(

)_____________

IMPORTANT:

A filing fee of $100 made payable to the Colorado State Treasurer must accompany this notice.

A copy of the Official Statement or Supporting Documents must accompany this notice

(Preliminary Official Statement or Draft Documents will suffice until Final Official Statement

or Final Documents are available.)

Be certain to indicate on the following pages of this form the exemption being claimed.

NOTE: No acknowledgement of this filing will be made unless one additional copy of this form and a stamped,

self-addressed envelope are provided.

Form Me - Notice Of Claim Of Exemption From Registration For Certain Municipal Securities