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PART IV <br />APPLICATION FOR <br />TAX-EXEMPT FINANCING <br />(Commercial, Industrial, Health Care or Other Non -Housing Projects) <br />1. APPLICANT <br />a. Business Name: <br />b. Business Address: <br />C. Business Form (corporation, partnership, sole proprietorship, etc.): <br />d. Authorized Representative: <br />e. Principal contact person and telephone number: <br />2. PURPOSE OF REQUESTED FINANCING: <br />a. New Facility (describe): <br />b. Expansion (describe): <br />C. Refunding (attach explanatory letter) <br />3. GIVE BRIEF DESCRIPTION OF NATURE OF BUSINESS, PRINCIPAL PRODUCTS, <br />ETC.: <br />4. ESTIMATED PROJECT COSTS: (Not required for refunding) <br />Land $ <br />Building <br />Equipment <br />Architectural, Engineering <br />Costs of Issuance — <br />Capitalized Interest, <br />including discount — <br />Other --- <br />Total Financing Requested $ - <br />5. AMOUNT OF FINANCING REQUESTED: $ (_ _% of project costs) <br />7 <br />