California > Statewide > State Treasurers Office > CDIAC
Drawn On Reserve-Default-Replenishment Form - California
| Drawn On Reserve-Default-Replenishment Form Form. This is a California form and can be used in CDIAC State Treasurers Office Statewide . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
CDIAC # STATE OF CALIFORNIA DRAW ON RESERVES/DEFAULT/ REPLENISHMENT* FORM FOR MELLO-ROOS / MARKS-ROOS ISSUE CALIFORNIA DEBT AND INVESTMENT ADVISORY COMMISSION 915 Capitol Mall, Room 400, Sacramento, CA 95814 P.O. Box 94809, Sacramento, CA 94209-0001 (916) 653-3269 FAX (916) 654-7440 For office use only Fiscal Year Received This form is submitted to the California Debt and Investment Advisory Commission in accordance with: (Please check one) Section 53359.5(c) of the California Government Code Mello-Roos Community Facilities Districts Default or Draw on Reserve Reporting. Section 6599.1(c) of the California Government Code Mark-Roos Bond Pooling Act Participants Default or Draw on Reserve Reporting Issuer: Bond Issue Title CFD No: Project Name: Actual Sale Date: This filing reports a: (Please check one) ________________________ ________________________ ________________________ _____________________ Default Draw on Reserve Date Draw on Reserve or Default Occurred: Amount of Draw on Reserve: $ Amount not paid but due in the Default: $ *Replenishment of Draw on Reserve (Voluntary Disclosure) Date of Replenishment of Draw on Reserve: Amount of Replenishment: Comments: $ Contact Information: Filing Contact Name: (Person filing Default/Draw on Reserve/Replenishment Report) Agency/Organization Name: Address: City: Telephone: E-mail Address: Date of Filing: State: Fax Number: Zip Code: 11/2011 American LegalNet, Inc. www.FormsWorkFlow.com
|
|||||||
