REPORT OF PROPOSED DEBT ISSUANCE
West Virginia State Treasurer's Office
State Capitol Complex, Suite E-145
Charleston, WV 25305
Completion and timely submittal of this form to the West Virginia State Treasurer's Office at the above address will assure your compliance with existing
West Virginia State law and will assist in the maintenance of a complete data base. Additionally, please enclose a copy of the preliminary official
statement (or offering circular) with this form or when it becomes available. Thank you for your cooperation.
NAME OF ISSUER:
ADDRESS OF ISSUER:
PROPOSED SALE DATE:
TYPE OF SALE: Competitive Negotiated
PROPOSED PRINCIPAL TO BE SOLD: $
IS THE INTEREST ON THE DEBT EXEMPT FROM TAXATION?
Under State law: NO (taxable) YES (tax-exempt)
Under Federal law: NO (taxable) YES (tax-exempt) If the issue is Federally tax-exempt, is interest a specific
preference item for the purpose of alternative minimum tax?
Yes, preference item No, not a preference item
IS ANY PORTION OF THE DEBT FOR REFUNDING?
No Yes, proposed amount for refunding $
TYPE OF DEBT INSTRUMENT
Tax anticipation General obligation
Tax and revenue anticipation Limited tax obligation
Revenue anticipation Revenue (Public enterprise)
Bond anticipation Conduit revenue (Private obligor)
Grant anticipation Special assessment
Tax allocation Tax allocation
Other note (Please specify below.) Other bond (Please specify below.)
FINANCING LEASE COMMERCIAL PAPER
CERTIFICATES OF PARTICIPATION OTHER (Please specify below.)
Please specify if "Other note/Other bond/OTHER" was checked:
SOURCE(S) OF REPAYMENT
Public enterprise revenues Tax-increment
Private obligor payments Special assessments
Bond proceeds Special tax revenues
Grants Property tax revenues
Intergovernmental transfers other than grants
Other (Please specify.):
§12-6A-6(2) of the West Virginia Code requires the issuer of any proposed new State debt issue to give written notice of the proposed sale to the Treasurer
no later than 30 days prior to the sale.