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<br />CITY OF ROSEVILLE <br />INDUSTRIAL REVENUE FINANCING <br /> <br />APPLICANT'S DATA <br /> <br />1. Applicant: <br /> <br />(a) <br />(b) <br />( c) <br /> <br />Business Name: <br /> <br />Business Address: <br /> <br />Business Form (corporation, partnership, sole proprietorship, etc.): <br /> <br />(d) <br />(e) <br />( f) <br />(g) <br /> <br />State of Incorporation or Organization: <br />Authorized Representative: <br /> <br />Phone: <br /> <br />Name(s) and Addresses of Major Stockholders or Principals; Applicants <br />and Principal Stockholders holding 10% or more (attach list if necessary): <br /> <br />1 ) <br />2) <br />3) <br /> <br />2. Primary Nature of Company's Business: <br /> <br />3. Total Amount of Industrial Revenue Bond Issue Requested: <br /> <br />Cost Breakdown: <br /> <br />Land Acquisition and Site Development <br />Construction Contracts <br />Equipment Acquisition and Installation <br />Architectural and Engineering Fees <br />Lega 1 fees <br />Interest During Construction <br />Initial Bond Reserve <br />Contingencies <br />Bond Discount or Underwriter <br />City Bond Consultant <br />City Administrative Expenses <br />