Application For Allocation Of Bonding Authority {Form H}

MINNESOTA MANAGEMENT & BUDGET TREASURY DIVISION APPLICATION FOR ALLOCATION OF BONDING AUTHORITY Pursuant to Minnesota Statutes, Chapter 474A, as amended Form H Application Form Revised August 2013 Page 1 of 1 NAME OF ISSUER: NAME OF PROJECT: AMOUNT OF ISSUANCE AUTHORITY REQUESTED: $ TYPE OF QUALIFIED BONDS TO BE ISSUED: Small Issue Bonds (for manufacturing projects and the Minnesota Rural Finance Authority) Student Loan Bonds DESCRIPTION OF PROJECT: Residential Rental Project Bonds Mortgage Bonds Public Facilities Bonds Enterprise Zone Bonds Governmental Bonds Redevelopment Bonds THIS COMPLETED APPLICATION FORM MUST BE ACCOMPANIED BY: 1. 2. 3. 4. 5. 6. A nonrefundable application fee of $20 for each $100,000 amount of issuance authority requested, with the request rounded to the nearest $100,000. The minimum fee is $20; A preliminary resolution adopted by the governing body; A statement from bond counsel that the proposed issue of obligations requires an allocation under M.S. 474A and the Internal Revenue Code; The type of qualified bonds to be issued (identify type on this Application Form H); An application deposit in the amount of 1% of the requested allocation before the last Monday in July or 2% on or after the last Monday in July; All issuers must pay the application fee and application deposit by separate checks made payable to Minnesota Management & Budget. Checks must be issued by the issuer. The Minnesota Housing Finance Agency, Minnesota Rural Finance Authority and, Higher Education Services Office may provide payment on a SWIFT Interagency Invoice. The federal employer identification number (FEIN) for the State of Minnesota is 41-6007162. For manufacturing projects and enterprise zone facility projects, a public purpose scoring worksheet (Form W) For residential rental projects, a statement from the applicant or bond counsel as to whether the project preserves existing federally subsidized housing and is restricted to persons who are 55 years or older. 7. 8. The following official of the issuer is designated for contact by Minnesota Management & Budget: NAME: TITLE: ISSUER: ADDRESS: CITY/STATE/ZIP: E-MAIL: PHONE NO. ( ) THE UNDERSIGNED CERTIFY THE ACCURACY OF THE ABOVE INFORMATION SUBMITTED WITH THIS APPLICATION: Mayor or Chief Administrator of Local Issuer Date Attorney for Local Issuer or Bond Counsel Date Send one original copy to: Minnesota Management & Budget, Treasury Division Attn: Susan Gurrola 400 Centennial Building, 658 Cedar Street St. Paul, Minnesota 55155-1489 American LegalNet, Inc. www.FormsWorkFlow.com