______________________________________________________________________
FINAL CERTIFICATION OF
PRIVATE ACTIVITY BOND ISSUANCE OR
MORTGAGE CREDIT CERTIFICATE PROGRAM ELECTION
- Council of Bond Oversight –
References: The Oklahoma Private Activity Bond Allocation Act (62 O.S. 695.21) and the Administrative Rules of the
Council of Bond Oversight.
_______________________________________________________________________________
Name of Issuer:
Issuer Address:
Issue or Project Title:
Issuer contact person & telephone number:
Type of Private Activity Bond or Mortgage Credit Certificate (MCC)(Qualified Small Issue,
Exempt Facility, Multifamily Residential, Student Loan, Mortgage Revenue Bond, MCC, etc.):
Amount(s) used from (the amount of Cap actually used):
Current State Ceiling:
Carryforward [include applicable year(s)]:
Dates of Issuance/Filing:
Bonds/Obligations Issued (1)
Carryforward Election Filed (1)
MCC Election Filed
(1) Note: File a Final Certification when a Carryforward Election is filed with the Internal Revenue
Service. Later, when bonds are issued, file another form to show amount(s) of Carryforward used
and the applicable year(s) from which the Carryforward amounts were allocated.
_______________________________________________________________________________
CERTIFICATION
I hereby certify that I am a duly authorized representative of the issuer and that the information provided herein is true and
correct to the best of my knowledge and belief.
Date: Signature:
Printed Name/Title:
_______________________________________________________________________________
FORM PA-2 (1/2005) PAGE 1 OF 1
