Michigan State - AABDS



Michigan Magnet Fund

[pic]

2005-2006

Application

for

New Market Tax Credit Financing

REVISION 7

|PROJECT NAME: |

|CITY: |

Due Date 9/30/05 with nonrefundable check made out to the

Michigan Magnet Fund I

|SECTION I – PROJECT IDENTIFICATION |

PART A. PRIMARY CONTACT PERSON:

Name Title

Organization

Street Address

City State Zip

Telephone # with Area Code Fax # with Area Code

E-Mail Address:

PART B. PROJECT LOCATION

(Attach location map – Exhibit A)

Project Name

Street Address

City Township County State Zip

PART C. PROJECT DESCRIPTION

Provide short description of the project (include site plan and elevation, if available under Exhibit B ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

PART D: TYPE OF CONSTRUCTION (Check applicable category)

New construction Acquisition and rehabilitation

PART E: PROJECTED JOB CREATION

# Temporary Jobs_____ # New Permanent Jobs______ # Retained Jobs__________

|Addendum I.SECTION II - SITE INFORMATION |

PART A. TYPE OF DEVELOPMENT (Check all applicable)

| Mixed-Use | Neighborhood Commercial | Office Building |

| Industrial | For Sale Housing | Downtown Development |

| Other, Describe: |

PART B. LOCATION CHARACTERISTICS OF PROJECT

1. Location Data: (Can be obtained from local city or township office)

|Is the Census Tract an Eligible NMTC Census Tract per CDFI? | Yes No |

|Census Tract # |County: |

|State Senate District # |State House District # |Congressional District # |

a) Is the Median Family Income less than 80% of State or MSA Median Family Income depending on whether community is in an MSA? Yes No

b) Is the Median Family Income less than 70% of State or MSA Median Family Income depending on whether community is in an MSA? Yes No

c) Is Poverty Level of the Census Tract Greater than 20%? Yes No

d) Is Poverty Level of the Census Tract Greater than 30%? Yes No

e) Is the Project located in a

i. Brownfield Yes No

ii. Empowerment Zones, Yes No

iii. HUB Zones Yes No

iv. HOPE VI neighborhoods, Yes No or a

v. Community approved Revitalization Area Yes No

vi. Enterprise Community Yes No.

vii. Renewal Community? Yes No If Yes, list that area here_____________

viii. Renaissance Zone? Yes No If Yes, list that area here:

ix. Cool City Area Yes No If Yes, list that area here:

x. Eligible distressed area? Yes No

To search the internet for the census tract number, go to:

and then to the Michigan Magnet Fund

2. Political Jurisdiction: City/Township of

Name and Title of CEO of Jurisdiction

Address

City State Zip

Contact name Department______________________

Street Address __

City State Zip

e-mail address __________________________________

Telephone # with Area Code Fax # with Area Code ___

3 Land Control Type:

Titleholder

Option to Purchase – Expiration Date:

Land Contract Vendee

Long-term Lease – Expiration Date:

Other

Describe:

Exhibit C attach documentation proving land control (deed or purchase agreement) for the development site and necessary title commitments

4. Environmental Clearance:

A Phase 1 Environmental Site Assessment, completed within 6 months of closing date, is required for all MMF Projects

Date Phase 1 Environmental Site Assessment completed _____________________ Attach in Exhibit D

Did the Phase 1 recommend additional Site Assessment Yes No

If Yes, when was the additional assessment completed ____________________

Does the assessment indicate a reportable environmental condition on the site? Yes No

If Yes, provide a copy of the MDEQ approved Remediation and/or Due Care Plan in Exhibit E

Is the remediation and due care requirements included in the development cost Yes No

Has a BEA with its due care requirements been filed with the MDEQ? Yes No

If yes, Date filed ____________________ Date approved ___________________

Complete only for Rehabilitation Residential Mixed Use Project

Has the site been tested or lead based paint? Yes No

If yes has a plan been adopted to mitigate the lead based paint problem in accordance with MSHDA guidelines Yes No

5. Community Revitalization Plan:

Is the project located in a qualified census tract for which a community development or revitalization plan is in place? Yes No

Demonstrate that the proposed development contributes to the revitalization plan? Yes No

Provide letter from City Planner or Mayor as part of Exhibit F.

5. Other Investment:

Does MSHDA or Great Lakes Capital or MEDA have a significant investment in the neighborhood? Yes, Provide Information on the projects as part of Exhibit G No

PART D. SPACE USAGE

|Land Area (acres): |Building Square Feet: |Number of Floors |

| | | |

|Building # |# of Floors |Size in Square Feet |

| | |Commercial |Residential |Other/Parking |Total |

|1 | | | | | |

|2 | | | | | |

|3 | | | | | |

|4 | | | | | |

|5 | | | | | |

|6 | | | | | |

| |Total | | | | |

PART E. PROJECTED TENANT INFORMATION

Complete the following:

|List All Commercial Tenants |Square Feet |Signed Leases? |Signed Letter of Intent? |Term of Lease |

|1. | | Yes No | Yes No | |

|2. | | Yes No | Yes No | |

|3. | | Yes No | Yes No | |

|4. | | Yes No | Yes No | |

|5. | | Yes No | Yes No | |

|6. | | Yes No | Yes No | |

|Total: | | | | |

|% of Total Building with signed Leases ______% |

Complete for Mixed Use Projects

|Building # |1 |2 |3 |4 |5 |

|Projected Gross Rent for Commercial space | | | | | |

|Projected Gross Rent for Residential Space | | | | | |

|Projected Total Gross Rents | | | | | |

|% Commercial Gross Rents/Total gross Rents | | | | | |

Do any of the tenants sell liquor as its primary business and will its prohibition be in the lease agreements Yes No

Do any of the tenants have gambling as its primary function Yes No

Do any of the tenants sell or contain collectibles Yes No

Do any of the tenants sell pornographic material Yes No

|SECTION III – OWNERSHIP / MANAGEMENT / DEVELOPMENT INFORMATION |

PART A. SPONSOR INFORMATION (General Partner/Developer)

1. Legal Name of Sponsor Taxpayer ID

Street Address

City State Zip

Contact Person

Telephone # with Area Code Fax # with Area Code

E-Mail Address:

Provide attorney letters that the sponsoring organization is a legally constituted organization and can enter into an agreement with the Michigan Magnet Fund or its subsidiary company. Exhibit G

PART B. OWNER INFORMATION (Limited Partnership)

1. Legal Name of Owner Taxpayer ID

Street Address

City State Zip

Contact Person

Telephone # with Area Code Fax # with Area Code

E-Mail Address:

Informational letters and documents requiring signatures will be sent to the contact person listed under Owner Information. Please make sure the name, street address, telephone number, and e-mail address are correct.

1. Type of Sponsor: (Check all that apply.)

| General Partnership | Limited Partnership | Individual |

| Corporation | Local Unit of Government | Limited Liability Company |

| Nonprofit | Publicly Traded Company | Joint Venture |

| Other, Describe: |

2. Type of Owner: (Check all that apply.) (QLICB)

| General Partnership | Limited Partnership | Individual |

| Corporation | Local Unit of Government | Limited Liability Company |

| Nonprofit | Publicly Traded Company | Joint Venture |

| Other, Describe: |

3. Legal Status of Owner:

| Currently Exists. |Tax Year: |From: |To: |

| To Be Formed. |Estimated Date: |

|Accounting Method of Partnership: | Cash | Accrual |

Attach Copy of organizing papers as part of Exhibit G

4. Complete the following:

|List Individuals/Organizations which Comprise the Ownership |Indicate Type of |Soc. Sec. or Taxpayer |% of |

|Entity |Organization |ID |Ownership |

| | | | |

| | | | |

| | | | |

| | | | |

Voluntary Information for Government Monitoring Purposes:

The following information is requested by the Michigan Magnet Fund for statistical purposes and relates to the majority/controlling interest in the owner(s) of the proposed development. Furnishing this information is optional. If you do not wish to furnish the following information, please initial below.

APPLICANT: I do not wish to furnish this information. (initials)

RACE/NATIONAL ORIGIN:

| Hispanic | Asian or Pacific Islander | Black |

| Am. Indian or Alaskan Native | Multiracial | White |

GENDER: Female Male

PART C - NMTC REQUIREMENTS

1. Does or will the ownership entity maintain a complete set of books and records for the eligible site? Yes No

2. Will the ownership entity have revenue within three years of closing on the allocation Yes, submit letter, refer to schedule in the application No

3. Will at lease 50% of the total gross income of the ownership entity will be derived from the active conduct of a qualified business within the low income area

4. Will 40% of the use of tangible property of the ownership entity be within the low income community described herein Yes No

5. Will at least 40% of the services performed for the ownership entity by its employees are performed in a low-income community. (% is determined based on a fraction the numerator of which is the total amount paid by the entity for employee services performed in the low income community and the denominator of which is paid b the entity for employee services Yes No

6. Does less than 5% of the average of the aggregate unadjusted basis of the property of such entity attributable to nonqualified financial property such as debt, stock, partnership interest, options, futures, forward contracts, warrants, annuities, etc. Yes No

A no answer to any of the above questions means that the project is not eligible to receive NMTC allocation.

PART D. DEVELOPMENT TEAM

1. Management Entity:

Firm Name Related Entity Yes No

Taxpayer Identification Number

Street Address

City State Zip

Contact Person

Telephone # with Area Code Fax # with Area Code

E mail Address:________________________________________

Voluntary Information for Government Monitoring Purposes:

The following information is requested by the Michigan Magnet Fund for statistical purposes and relates to the majority/controlling interest of the proposed development. Furnishing this information is optional. If you do not wish to furnish the following information, please initial below.

APPLICANT: I do not wish to furnish this information. (initials)

RACE/NATIONAL ORIGIN:

| Hispanic | Asian or Pacific Islander | Black |

| Am. Indian or Alaskan Native | Multiracial | White |

GENDER: Female Male

2. Project Attorney:

Firm Name Related Entity Yes No

Street Address

City State Zip

Contact Person

e-mail address __________________________________

Telephone # with Area Code Fax # with Area Code

3. Project Accountant:

Firm Name Related Entity Yes No

Street Address

City State Zip

Contact Person

e-mail address __________________________________

Telephone # with Area Code Fax # with Area Code

4. Consultant:

Firm Name Related Entity Yes No

Street Address

City State Zip

Contact Person

e-mail address __________________________________

Telephone # with Area Code Fax # with Area Code

5. Builder/Contractor:

Firm Name Related Entity Yes No

Street Address

City State Zip

Contact Person

e-mail address __________________________________

Telephone # with Area Code Fax # with Area Code

6. Architect:

Firm Name Related Entity Yes No

Street Address

City State Zip

Contact Person

e-mail address __________________________________

Telephone # with Area Code Fax # with Area Code

7. Engineer:

Firm Name Related Entity Yes No

Street Address

City State Zip

Contact Person

e-mail address __________________________________

Telephone # with Area Code Fax # with Area Code

8. Other (Describe):

Firm Name Related Entity Yes No

Street Address

City State Zip

Contact Person

e-mail address __________________________________

Telephone # with Area Code Fax # with Area Code

| |

|SECTION V - PROJECT SCHEDULE |

|Modify as needed |Actual Date |Anticipated Completion Date |

| SITE |

|Acquisition of Land | | |

|Acquisition of Building(s) | | |

|Site Plan Approval | | |

|All Site Utilities in Place | | |

|Historic Tax Credits Part 1 Approved | | |

|Historic Tax Credits Part 2 Approved | | |

|Brownfield Plan (SBT) Approval (Local) | | |

|Brownfield Plan Approval (SBT) (State) | | |

|Brownfield Plan Approval (Local) (SBT) | | |

|Brownfield Plan Approval (State) (SBT) | | |

|Obsolete Property or Other Property Tax Incentive | | |

|LEASE – UP |

|Begin Lease-up | | |

|Substantial Rent-up | | |

|Placed in Service Date | | |

|Certificate of Occupancy Issued | | |

|Completion of Project Audit by CPA | | |

| CONSTRUCTION FINANCING |

|Firm Loan Approval(s) | | |

|Closing and Disbursement of Funds | | |

| PERMANENT FINANCING |

|Firm Approval of Loan(s) | | |

|Closing and Disbursement | | |

| GRANTS/SUBSIDIES |

|Firm Approval(s) | | |

|Closing and Disbursement | | |

| OWNERSHIP ENTITY FORMATION |

|Articles of Incorporation/Certificate and Agreement of | | |

|Partnership | | |

| CONSTRUCTION/REHABILITATION |

|Building Permit Issued | | |

|Final Plans and Specifications | | |

|Construction Start | | |

|50% Completion | | |

|Construction Completion | | |

|SECTION VI - DEVELOPMENT FINANCING |

As part of the application, the owner must submit a commitment letter from a Michigan Magnet Fund investment partner listed below indicating the maximum debt financing ($___________) they would provide if new market tax credits were not be available and the owner’s equity investment was increased. The letter must also indicate that but for a New Market Tax Credit Allocation they would not finance the project or that the owner would not invest in the low income census tract.

The letter should indicate that the investment partner is willing to make a total qualified equity investment (QEI) in a Michigan Magnet Fund subsidiary of $____________ either directly or as part of a leveraged financing and a projected closing date. Include details in Exhibit H. In a leveraged model indicate both the terms of the debt $________and the equity investment $_______ The letter should Include a commitment for all sources of financing including historic tax credits, brownfield SBT, and so on. The projected closing date is:________________

NOTE: Magnet Fund investment partners include:

Irwin Union Bank,

Huntington CDC,

Wells Fargo CDC,

Comerica Capital Advisors, Inc.,

Greenleaf Trust

First Independence Bank of Detroit

Charter One Bank

Fifth Third CDC

Key CDC

National City Bank

LaSalle Bank/Standard Federal Bank

PART A. SUBSIDIES AND GRANTS

1. Will the project receive local governmental support in the form of tax abatement?

Yes. Describe:

No.

2. Will the project receive local subsidies or any type of local, state or federal government support?

Yes. Complete the following: (List all Federal, State and Local Funding)

|Funding |Dollar Amount |Amount Included in |Commitment Documentation |

| | |QEI |Attached |

| |Grant |Loan | | |

|SBT Tax Credit | | | | Yes No |

|HOME Funds | | | | Yes No |

|EDA | | | | Yes No |

|Local Financing | | | | Yes No |

|CDBG Program | | | | Yes No |

|State Historic Tax Credit | | | | Yes No |

|Federal Historic Tax Credit | | | | Yes No |

|HUD 108 Loan | | | | Yes No |

|BEDI Grant | | | | Yes No |

|Foundation | | | | Yes No |

|State TEDF Grant | | | | Yes No |

|State Transportation Enhancement | | | | Yes No |

|Other (Describe) | | | | Yes No |

|Other: (Describe) | | | | Yes No |

|TOTAL | | | | |

No.

Insert copies of commitment Letters in Exhibit H

PART B. SOURCE & USES OF FUNDS

|SECTION VII – SOURCE & USES OF FUNDS |

|USE OF FUNDS |Amount |

|LAND |

|Land Purchase | | |

|Closing/Title & Recording | | |

|Real Estate Expenses | | |

|Other Land Related Expenses | | |

|SUBTOTAL | | |

|BUILDING ACQUISITION |

|Existing Structures | | |

|Demolition (Exterior) | | |

|Other, Describe: | | |

|SUBTOTAL | | |

|SITE WORK |

|On Site | | |

|Off Site Improvement | | |

|Other: (Describe) | | |

|SUBTOTAL | | |

|NEW CONSTRUCTION/REHAB |

|New Structures | | |

|Rehabilitation | | |

|General Requirements | | |

|Builder Overhead | | |

|Builder Profit | | |

|Construction Contingency | | |

|Other: (Describe) | | |

|SUBTOTAL | | |

|Design Architect | | |

|Supervisory Architect | | |

|Real Estate Attorney | | |

|Engineer/Survey | | |

|Tap Fees/Soil Borings | | |

|Permits & Fees | | |

|Other, Describe: | | |

|SUBTOTAL | | |

|Builders Risk Insurance | | |

|Other Insurance | | |

|Interest | | |

|Loan Origination Fee | | |

|Loan Enhancement | | |

|Title & Recording | | |

|Legal Fees | | |

|Taxes | | |

|Other, Describe: | | |

|SUBTOTAL | | |

|Bond Premium | | |

|Credit Report | | |

|Loan Origination Fee | | |

|Loan Credit Enhancement | | |

|Title & Recording | | |

|Legal Fees | | |

|Taxes | | |

|Other: (Describe) | | |

|SUBTOTAL | | |

|Feasibility Study | | |

|Market Study | | |

|Environmental Study | | |

|New Market Tax Credit Origination Fee | | |

|New Market Tax Credit Professional Fees | | |

|Marketing/Rent-up | | |

|Cost Certification | | |

|Bridge Loan Exp. (During Construction) | | |

|Other: (Describe) | | |

|SUBTOTAL | | |

|Organizational | | |

|Bridge Loan Cost | | |

|Tax Opinion | | |

|Other: (Describe) | | |

|Other: (Describe) | | |

|SUBTOTAL | | |

|Developer Fee | | |

|Consultant Fee | | |

|Other: (Describe) | | |

|SUBTOTAL | | |

|Rent Up Reserves | | |

|Operating Reserves | | |

|Replacement Reserves | | |

|Other: (Describe) | | |

|SUBTOTAL | | |

|TOTAL USES OF FUNDS | | |

|SOURCES OF FUND (Assume Leveraged Model) |Amount |Total |

|QEI |

| Grant/Loan Proceeds (Section VI, a, 2) In QEI | | |

| Debt Committed to Investment Entity | | |

|(Assume Leverage Model) | | |

| Other (Describe) | | |

|NMTC Equity Investment | | |

|Total QEI | | |

|Non QEI Investment |

| Developer Equity Investment | | |

| Debt not In QEI | | |

| Grant/Loan Proceeds (Section VI, a, 2) not in QEI | | |

| Other: | | |

| Other: | | |

| Total Non QEI Investment | | |

|TOTAL SOURCES OF FUNDS | | |

PART C: APPRAISAL

Provide a copy of an as built appraisal for the projected development in Exhibit I using the development plans and financial data provided herein.

| |

|SECTION VIII - ANNUAL PROJECT OPERATING EXPENSES |

|PART A. ADMINISTRATION |Project Costs |

|Accounting | | |

|Advertising | | |

|Legal | | |

|Leased Equipment | | |

|Management | | |

|Management Salaries & Payroll Taxes | | |

|Office Supplies/Postage | | |

|Telephone | | |

|Annual Compliance Fees | | |

|Other: (Describe) | | |

|Total Administrative Costs | | |

|PART B. OPERATING | | |

|Fuel (Heat/Water) | | |

|Electricity | | |

|Water/Sewer | | |

|Gas | | |

|Trash Removal | | |

|Security | | |

|Cable TV | | |

|Other: (Describe) | | |

|Total Operating Expenses | | |

|PART C. MAINTENANCE | | |

|Elevator | | |

|Extermination | | |

|Grounds | | |

|Repairs | | |

|Maintenance Salaries/Payroll Taxes | | |

|Maintenance Supplies | | |

|Snow Removal | | |

|Cleaning & Decorating | | |

|Other: (Describe) | | |

|Total Maintenance Expenses | | |

|PART D. FIXED | | |

|Real Estate Taxes | | |

|Payment in Lieu of Taxes | | |

|Other Tax Assessment | | |

|Annual Depreciation Expense | | |

|Insurance | | |

|Other: (Describe) | | |

|Total Fixed Expenses | | |

| | |

|TOTAL PROJECT EXPENSES: | |

| | |

|PART E. ANNUAL REPLACEMENT RESERVES | |

| | |

|PART F. ANNUAL DEBT SERVICE | |

|SECTION X – PROJECT PRO-FORMA |

PART A: Sources of Revenue:

Indicate all sources of Revenue including annual rents, annual tax increment payments (Include copies of brownfield plan and MEGA approval letter as part of Exhibit H, annual common area fees, other services, annual foundation grants, other source, etc. If a mixed use project, indicate revenue from each use. Indicate start up assumptions.

|Sources of Revenue |Year 1 |Year 2 |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

|Total Revenue | | |

Indicate the assumptions you used for the projections (MUST BE CARRIED OUT FOR TEN YEARS)

Projected Annual Percentage Increase in Income: %

Projected Annual Percentage Increase in Expenses %

Projected Annual Vacancy Rate Percentage: %

Projected Annual Percentage Increase in Replacement Reserves: %

| |Year 1 |Year 2 |Year 3 |Year 4 |Year 5 |

|Total Revenue | | | | | |

|Less Vacancy Amount | | | | | |

| Effective Gross Income | | | | | |

|Less Operating Expenses | | | | | |

| Net Income | | | | | |

|Plus Depreciation Expense | | | | | |

| Net Operating Income (NOI) | | | | | |

|Plus Tax Increment Financing | | | | | |

| Net Cash Flow | | | | | |

|Less Debt Service | | | | | |

|Less Replacement Reserve | | | | | |

| Net Cash Flow | | | | | |

| |Year 6 |Year 7 |Year 8 |Year 9 |Year 10 |

|Rental Income | | | | | |

|Less Vacancy Amount | | | | | |

| Effective Gross Income | | | | | |

|Less Operating Expenses | | | | | |

| Net Income | | | | | |

|Plus Depreciation Expense | | | | | |

| | | | | | |

| Net Operating Income (NOI) | | | | | |

|Plus Tax Increment Financing | | | | | |

|Less Debt Service | | | | | |

|Less Replacement Reserve | | | | | |

| Cash Flow | | | | | |

|SPONSOR EXPERIENCE |

|1. |Sponsor Name: |

|2. | |

|3. | |

|Name of |Address |City and State |Date of Ownership |Date Last Placed in |Value |

|Project Owned | | |(mm/dd/yy) |Service (mm/dd/yy) | |

| | | |Begin |End | | |

| | | | | | | |

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|MANAGEMENT EXPERIENCE |

|1. |Management Entity: | |

|2. |Is the management entity identified above the same as shown earlier of this application? Yes No |

| |If you answered “No”, explain the relationship between the management entity shown on this page to the management entity in the application: |

|3. |Complete the chart below. If applying for Tax Credits, failure to fully complete this chart or clearly define the relationship between the management |

| |entity identified here and on Page 7 of this application will result in loss of points. |

|Name of |City and State |Type of Use |Date of |Number of square |Number of tenants |

|Project Managed | | |Management |feet | |

| | | |(mm/dd/yy) | | |

| | | |Begin |End | | |

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Impact on Residents and Businesses in Low Income Communities

Please remember when answering these questions that in order to be eligible for New Market Tax Credits your development is located in a low income community (qualified low income census tract) that contains residents and/or businesses Please indicate how you will an impact on any of the areas in 1 – 5. You are not expected to impact every area.

MMF may require all borrowers to utilize the local Michigan Works! Employment Agency on nonexclusive basis to help identify individuals for new positions. MMF's compliance group will monitor the collection of data for CDFI's CIIS and for Michigan Works! This may need to be a condition of your lease agreement with your tenants. Is this acceptable? Yes No

If not, explain

________________________________________________________________________________________

_______________________________________________________________________________________

1. Will you provide goods and services to Low-Income Persons or residents of the Low-Income community your facility is located. Yes No Explain

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

2. Does your development provide childcare, health care, educational or other benefits to Low-Income Persons or residents of the Low-Income community. Yes No Explain

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

3. Are you a businesses owned by residents of, or otherwise committed to remain in Low-Income Communities? Yes No Explain

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

4. Will you create or retain jobs for Low-Income Persons or residents of Low-Income Communities? Yes No Explain

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

5. Will you increase wages or incomes for Low-Income Persons or residents of Low-Income Communities

Yes No Explain

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Indicate the economic impact of your development on the low-income community.

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Exhibits

Check if included

A. Location Map

B. Site Plan & Elevations

C. Land Control & Title Commitments

D. Phase 1 Environmental Site Assessment

E. MDEQ Remediation Plan and/or BEA

F. Letter of Support

G. Organizational

H. Subsidy and Grant Commitments

I. Appraisal

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QUALIFIED EQUITY INVESTMENT REQUESTED:

$

Provide q copy for each Sponsor owning 10% or greater ownership interest

Project Number_________

Date Received _________

To be completed by MMF

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