Treasurer.sc.gov



STATE OF SOUTH CAROLINA

OFFICE OF THE STATE TREASURER

FILING FOR DEBT ISSUE BY POLITICAL SUBDIVISION

1. (a) Name of Issuer:

(b) County where Issuer is located: __________________________________

2. Issuer Category:

(a) County

(b) Municipality

(c) School District

(d) Special Purpose District

(e) Other ______________________________________

3. Date and Title of Issue:

4. Type Obligation:

(a) General Obligation Bond

(b) General Obligation BAN, TAN

(c) Revenue Bond

(d) Other _________________________________________

(Specify - i.e.: capital lease, note, mortgage, loan, etc.)

5. Purpose of Issuance:

(a) Water Utility

(b) Electric Utility

(c) Gas Utility

(d) Industrial Revenue

(e) Single Family Mortgage Revenue

(f) Sewer System

(g) Parks/Recreation

(h) Streets/Bridges

(i) Drainage/Flood Control

(j) Government Facilities:

(k) Other – Specify:

6. Original Principal to be Borrowed: $

7. Interest Rate: %

If more than one rate, give average effective rate .

8. Schedule of Principal Amounts Due and Rates for the above Indebtedness (Use Schedule of Principal):

9. Schedule of Principal and Interest Due for the above Indebtedness (Use Schedule of Principal and Interest):

|By: ___________________________________________ |

| ____________, Bond Counsel to _______________ |

Received this _______ day of ____________, 20__.

|By: ___________________________________________ |

| For the State Treasurer of the State of South Carolina |

| | | | | | | |

Exhibit A

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