Form 4463 - Request For Carryforward Allocation

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Michigan Department of Treasury

Form 4463 (Rev. 01-12)

Request for Carryforward Allocation

Issued under authority of Public Act 496 of 1988.

Name of issuer

Date

Total principal amount of issue

If refund issue, amount in excess of obligation to be refunded

Amount requested for carryforward

CARRYFORWARD REQUEST DETAILS

Fill in only one project per numbered box.

Project(s)

Portion of Allocation

Year (carryforward allocation to)

Name of legal counsel tax exempt opinion:

Has any previous request been made by or on behalf of the issuer for the issue?

Yes

NOTE: You must attach a copy of an inducement resolution or other comparable preliminary approval.

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.

Signature

Date

Print Name

Print Title

Municipal Address

Telephone Number

Return this form and all attachments to:

US Mail

Overnight Mail

Bureau of State and Authority Finance

Department of Treasury