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Minnesota Public Facilities Authority <br />FORM 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 />(Note: The City may need to consult with their attorney in order to complete this checklist.) <br />Item <br />Question <br />Response <br />Yes/No <br />1 <br />Does the Applicant own all of the project assets to be financed <br />Ownership <br />(land, facilities, buildings)? <br />chose one <br />Lease and Other <br />2 <br />Is any part of a Financed Asset leased pursuant to a lease or similar <br />Rights <br />agreement for more than 50 days? <br />chose one <br />3 <br />Has the Applicant entered into an agreement with another entity <br />Management <br />to manage the operation of the Financed Assets? (for example, <br />or Services <br />odes a private entity operate the System on behalf of the <br />chose one <br />Agreements <br />Applicant) <br />4 <br />Has the Applicant entered into any agreement with an individual or <br />entity that grants special legal rights to the Financed Asset or <br />chose one <br />Output <br />permits any entity to purchase output of the system other than at <br />Agreements & <br />retail (e.g., has the Applicant entered into a take agreement, a take <br />Other Use <br />or pay agreement, a requirements agreement, or similar <br />agreement related to output from the Financed Assets)? <br />5 <br />If the answer to 2, 3 or 4 is "Yes", has the City's attorney or bond <br />Legal Review <br />counsel reviewed the agreements for conformance with IRS tax- <br />chose one <br />exempt rules and regulations? <br />GO Bond Special Appropriation Forms 15 of 32 August 2023 <br />