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APPLICATION FOR PRIVATE ACTIVITY BOND ALLOCATION This application (Kansas Department of Commerce)

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1/13/16
APPLICATION FOR PRIVATE ACTIVITY BOND ALLOCATION
This application is provided for use pursuant to the Kansas Private Activity Bond Allocation Act,
and Section 146(e) of the Internal Revenue Code. All bond issuers shall complete and file this
application with the Secretary of Commerce prior to issuing any Private Activity Bonds that are
subject to the State Ceiling (as such terms are defined in the aforesaid Code).
Complete one (1) Application for Each Project or Financing (please print or type).
Amount of allocation requested:
Allocation Number:
(To be completed by Department of Commerce)
PART (A) BOND ISSUER
1.
Bond Issuer Name:
State:
KS
Zip:
2.
Bond Issuer’s Spokesperson:
Spokesperson’s Title:
State:
Zip:
Telephone Number:
Email:
3.
Has the issuer sought and received preliminary determination from bond counsel that
bonds issued for the proposed project can be qualified as tax-exempt obligations under
the applicable section(s) of the Internal Revenue Code?
Yes
No
4.
Bond Attorney:
Bond Firm:
Address:
City:
State:
Zip:
Telephone Number:
Email:
5.
Bond Trustee:
Address:
City:
State:
Zip:
Telephone Number:
Email:
6.
Governmental Units having jurisdiction over proposed project or financing:
7.
Highest elected officer of governmental unit having jurisdiction over project or financing:
8.
Has a public hearing been held concerning the proposed project or financing?
Yes
No
Not Required
1/13/16
9.
If the answer to the preceding question is No, when will a public hearing be held?
10.
Has said officer described in Question 7 above approved project or financing?
Yes
No
PART (B) DESCRIPTION OF PROJECT OR FINANCING
1.
Type of Bonds (as specified in Sections 141 of the Internal Revenue Code of 1986)
(check only one)
Type of Bond
A.
Exempt Facility Bonds
Mass commuting facilities
Facilities for the furnishing of water
Sewage facilities
Solid waste disposal facilities
Qualified residential rental project
Facilities for the local furnishing of electric energy
or gas
Local district heating or cooling facilities
Qualified hazardous waste facilities
B.
Qualified Mortgage Bonds
C.
Qualified Small Issue Bonds
D.
Qualified Student Loan Bonds
E.
Qualified Redevelopment Bonds
F.
Private activity portion of government use bonds
G.
Tax Reform Act of 1986 Transition Rule
H.
Other (specify):
2.
Principal, beneficiary of the facility or activity to be financed with the proceeds of bonds
described in 1.(A), (C), (F), (G), or (H):
Beneficiary:
Address:
City:
State:
Zip:
3.
Project Location:
City:
State:
Zip:
Type of project or purpose for which bonds are to be issued (please be descriptive, e.g.,
manufacturer of plastic food trays; apartment project, construction of manufacturing
facility etc.):
1/13/16
4.
Type of business:
New
Not Applicable
5.
Total Project Capital Investment (including PAB requested):
6.
Estimate number of new jobs to be generated from proposed project:
Initially:
Permanent:
Percentage breakdown of types of jobs to be created (e.g., 50% labor, 30% support,
20% management):
Labor
Support
Management
Average hourly wage of newly created jobs:
7.
Housing projects
Number of rehabilitated units:
Number of new units:
8.
Is HUD UDAG financing involved with the project?
Yes
No
If Yes, date UDAG application submitted
PART (C) DATE OF COMMITMENT
Date of Inducement Resolution or other commitment to issue was
adopted. (Attach copy if other than Mortgage Revenue Bonds):
I certify that the above information is accurate to the best of my knowledge and that I am
authorized to submit this application on behalf of the bond issuer.
Signature of Issuer’s Spokesperson:
Date:
Return to:
Secretary of Commerce
Kansas Department of Commerce
1000 S.W. Jackson Street, Suite 100
Topeka, Kansas 66612-1354
(785)
296
-5298
FAX: (785) 296-3490
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1/13/16
To be completed by Kansas Department of Commerce
Application
Approved:
Placed on hold pending receipt of additional information:
Placed on hold pending review:
Amount:
Allocation Number:
Expiration Date:
____
_______________________________________________________________________________________________________________________________________________
Secretary of Kansas Department of Commerce
Private Activity Bond Application
Economic Impact Data
The Kansas Department of Commerce requires this data to facilitate the study of the economic impact of PAB
issuance in Kansas.
Total Project Capital Investment (including PAB issued)
Number of projected jobs created by PAB project at:
Conclusion of one year from bond issuance
Five years from bond issuance
Housing projects:
Number of rehabilitated units
Number of new units
Percentage breakdown of types of jobs to be created (e.g., 50% labor, 30% support, 20%
management):
Labor
Support
Management
Average hourly wage of newly created jobs
1/13/16
1117 | 12/6/17 |
| KMD
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APPLICATION FOR PRIVATE ACTIVITY BOND ALLOCATION This application (Kansas Department of Commerce)

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Completed 20 July 2020

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