Form 14429 - Tax Exempt Bonds Voluntary Closing Agreement Program Request Page 2
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Additional Party Information
If the issuer proposes to include additional parties to the closing agreement please provide
7. Additional party’s name
8. Additional party’s EIN
9. Address
(number, street)
City
State
ZIP code
10. Name and title of official of additional party who may be contacted for additional information
11. Phone number of official listed on line 10
12. Role of additional party
(e.g., conduit borrower, trustee)
13. Is Form 8821, Tax Information Authorization, attached for the additional party to inspect and/or receive information about the
issuer? IRM 7.2.3.2.1(6)
Yes
N/A
Page number
14. Is Form 8821 attached for the issuer to inspect and/or receive information about the additional party? IRM 7.2.3.2.1(6)
Yes
Page number
N/A
Note: If more than one additional party, provide the information and Forms 8821 required in lines 7 through 14 for each additional party
on an attached schedule.
Authorized Representative Information
15. Is Form 2848, Power of Attorney and Declaration of Representative, for each authorized representative attached? IRM 7.2.3.2.1(6)
Yes
Page number
N/A
16. Name and title of authorized representative
17. PTIN of authorized representative
18. Telephone number of authorized representative
19. Address
(number, street)
City
State
ZIP code
Note: If more than one authorized representative, provide the information and Forms 2848 required in lines 15 through 19 for each
additional representative on an attached schedule.
Bond Information
See IRM 7.2.3.2.1(2)(B) for more information
20. Name of bond issue
21. Issue date of bond issue
22. CUSIP number (if any) reported on Form 8038 Series information return filed in connection with the issuance of the bond issue(s)
23. Issue price
24. Is a full debt service schedule for the issue showing principal maturities and interest rates (for variable rate issues include a
description of how the rate is set and the interest payments to the date of the request) attached
Yes
N/A
Page number
25. Is a copy of the Form 8038 Series information return filed in connection with the issuance of the bond issue(s) and submitted to the
IRS attached? IRM 7.2.3.2.1(5)
Yes
N/A
Page number
14429
Catalog Number 60719A
Form
(3-2013)
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