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PART IV <br /> • <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 /> 356755v2 SJB AR200-7 7 <br />