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FFORM 3 – TAX-COMPLIANCE CERTIFICATION CHECKLIST <br />Applicant: <br />Person Completing Form: <br />Date Form Completed: <br />Applicant’s Tax Compliance Officer: <br />Description of Financed Assets: <br />Item Question Response <br />Yes/No <br />1 <br />Ownership <br />1 Does the Applicant own all of the project assets to be financed <br />(land, facilities, buildings)? <br />2 <br />Lease and Other <br />Rights <br />2 Is any part of a Financed Asset leased pursuant to a lease or similar <br />agreement for more than 50 days? <br />3 <br />Management or <br />Services <br />Agreements <br />3 Has the Applicant entered into an agreement with another entity <br />to manage the operation of the Financed Assets? (for example, <br />odes a private entity operate the System on behalf of the <br />Applicant) <br />4 <br />Output <br />Agreements & <br />Other Use <br />4 Has the Applicant entered into any agreement with an individual or <br />entity that grants special legal rights to the Financed Asset or <br />permits any entity to purchase output of the system other than at <br />retail (e.g., has the Applicant entered into a take agreement, a take <br />or pay agreement, a requirements agreement, or similar <br />agreement related to output from the Financed Assets)? <br />5 <br />Legal Review <br />5 If the answer to 2, 3 or 4 is “Yes”, has the City’s attorney or bond <br />counsel reviewed the agreements for conformance with IRS tax- <br />exempt rules and regulations? <br />Minnesota Public Facilities Authority 2020 Special Appropriation Forms <br />12 of 28 October 2020 <br />City of Arden Hills <br />Gayle Bauman <br />10/25/2021 <br />Gayle Bauman <br />Yes <br />No <br />No <br />No <br />N/A