Form 1432 - Application For Exemption - Michigan Department Of Treasury

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Michigan Department of Treasury
This form is issued under authority of P.A. 34
1432 (Rev. 7-09)
of 2001, as amended. Filing is voluntary.
Application For Exemption
INSTRUCTIONS: Complete all parts of this application. The Department of Treasury may request additional information.
FILE WITH: Local Audit & Finance Division, Michigan Department of Treasury, P.O. Box 30728, Lansing, MI 48909-8228.
Direct questions to (517) 373-0660 or e-mail to Treas_MunicipalFinance@michigan.gov.
The municipality identified below applies for an exemption from the following requirements:
Refunding Exemption
Rating
Discount Exceeding 10%
Other
Legal Name of Municipality
Legal Classification
County(ies)
Title of Security
Amount of Security
Issue Date
Date of Sale or Delivery
REASON FOR REQUEST
ADVANTAGES TO MUNICIPALITY
CERTIFICATION: I, the undersigned, certify that this application and the attachments were authorized by the governing
body of this municipality and that they are complete and accurate in all respects.
Name of Bond Attorney
Name of Firm
Date
Name of Financial Consultant
Name of Firm
Date
Chief Administrative Officer Name (Typed or Printed)
Chief Administrative Officer's Signature
Date
Telephone Number
Municipal Address
(
)

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