Report To Bureau Of Securities Department Of Finance (Form For Industrial Bond Issuers)

REPORT TO BUREAU OF SECURITIES, DEPARTMENT OF FINANCE UNDER SECTION 50-2709, IDAHO CODE The undersigned, ___________________________________________________ ________________________________________________________________________ hereby certifies the following information: 1. Issuer: 2. Bonds issued: 3. Date of issuance: 4. Facilities constituting the project: 5. Persons on behalf of whom the Issuer issued the bonds: 6. The amount of permanent employment reasonably expected to be created by the existence of the project: DATED as of the ________ day of _______________________, _________. B y_________________________________ ( I ssuer) APPROVED AND VERIFIED BY: By_________________________________ (Beneficiary) REPORT TO BUREAU OF SECURITIES