STATE OF TEXAS

APPLICATION FOR QUALIFIED HURRICANE IKE DISASTER AREA BOND DESIGNATION

This application is required pursuant to the Proclamation of the Governor of the State of Texas issued on December 7, 2009, providing for administration of the qualified Hurricane Ike disaster area bond program and establishing priorities for the designation of such bonds.

**APPLICATION FEE: $1,000

Fees should be sent to: Comptroller of Public Accounts

Item Processing – Lock Box Section

208 E. 10th Street

Austin, TX 78701

TO: Program Administrator

Texas Bond Review Board

300 W. 15th Street, #409

Austin, Texas 78701-1649

DUPLICATE: Director, Division of Disaster Recovery and Renewal

Office of the Governor

P.O. Box 12428 Hand delivery: 1100 San Jacinto Avenue

Austin, Texas 78711 Austin, TX 78701

Name of Project

Parties (only include applicable items)

1.  Issuer

Issuer Name:
Principal Contact:
Address:
Telephone:
E-mail:
Issuer’s Authorizing State Statute:

2.  Obligor/Project User

Name:
Principal Contact:
Address:
Telephone:
E-mail:
Business Structure:
State and Date of Incorporation/ Creation:

3.  Issuer’s Sponsoring Governmental Unit

Name:
Principal Contact:
Address:
Telephone:
E-mail:

4.  Bond Counsel

Name:
Principal Contact:
Address:
Telephone:
E-mail:

5.  Underwriter

Name:
Principal Contact:
Address:
Telephone:
E-mail:

6.  Financial Advisor

Name:
Principal Contact:
Address:
Telephone:
E-mail:

7.  Authorized Representative of Issuer

Name:
Principal Contact:
Address:
Telephone:
E-mail:

8.  Others: Please indicate any others you would like to receive emailed requests for further information or notifications regarding reservations.

NAME / E-MAIL

Bond Qualification Details

9. Designation is hereby requested in the principal amount of $

In the event that the State is unable to grant a designation for the full amount requested, applicant will not accept a designation less than $

10. Qualified Project Type

Nonresidential Real Property

Public Utility Property

Qualified Residential Rental Project

Qualified Mortgage Loans for single family housing for homeowners who suffered home damage in Hurricane Ike

11. Location of Project or single family homes (include county and zip codes)

Project Details

Complete the questions under this heading for projects other than qualified mortgage loans.

12. Did the entity that will own or use the Project suffer a loss in Hurricane Ike?

Yes
No
Yes
No

If not, will the entity that will own or use the Project be carrying on a trade or business replacing a trade or business with respect to which another person suffered a loss attributable to Hurricane

Ike?

13. Briefly describe the Project, the extent to which it involves repair or replacement of property damaged by Hurricane Ike, and the type of business of Obligor/User.

14. Estimated project costs broken down by:

Land
Building
Equipment
Interest during Construction
Costs of Issuance and net Original Issue Discount
Other
TOTAL
Less other sources of funds
Bond Amount*

*The total bond amount should equal the amount in Question #9.

15. Anticipated total payroll resulting from or expected to be saved by Project $

16. Unemployment from the Texas Workforce Commission from the most recent month of the county (ies) or Metropolitan Statistical Area (MSA) in which the Project is located?

17. Number of expected full-time equivalent jobs to be created?

Number of expected full-time construction/temporary jobs?

18. Average salary of permanent jobs created

19. Does the Project development plan provide jobs that enhance opportunities for Texas in technology, advanced manufacturing, environmental processing or other areas that provide for a specialized workforce? If so, how?

20. Is a workforce training program a component of the Project’s development plan?

21. In what other way would financing of the Project with tax-exempt bonds further the public interest?

22. Key Dates

DATE (M/D/Y)
When designation is required
Estimated completion of plans and specs
Estimated commencement of construction
Estimated completion of construction
Estimated date project to be placed in service

Project Financing

23. Expected closing date

24. Has this Project received a previous reservation for tax-exempt financing?

Yes
No

Is this Project eligible for any other type of tax-exempt financing?

Yes
No

If yes, please explain why this Project should receive Ike Bond allocation as opposed to pursuing other types of tax-exempt financing.

*Use continuation sheet to provide additional information.

Application Attachments

25. Certification Regarding Fees & Check Copy, on the form prescribed by the Board

Inducement Resolution or Preliminary Action

Legal Counsel Opinion (Qualified Hurricane Ike Bond and authorization under state law)

Issuer's Certified Articles of Incorporation and Bylaws

Issuer's Certificate of Continued Existence

Obligor’s/User's Articles of Incorporation and Bylaws

Obligor’s/User’s Certificate of Continued Existence (except for qualified mortgage loans)

Obligor’s/User's Certificate of Good Standing (including partners or parents) (except for qualified mortgage loans)

Estimated Sources and Uses of Funds

Project Certification

26. Certification: The information contained in this Application for qualified Hurricane Ike disaster area bond designation and related attachments is, to the best of our knowledge, true and accurate.

______

(Name of Issuer)

______

(Signature)

_____

(Name/Title)

______

(Date)