Camden County Improvement Authority

MERCER COUNTY IMPROVEMENT AUTHORITY

APPLICATION FOR FINANCING

I. APPLICANT:

1 Name ______Date: ______

2 Address ______

3 Phone Number ______

4 E-mail address ______

5 Fax Number ______

6 Contact Person ______Title:______

7 Type of organization (please put check in appropriate box)

a.  Individual b.  Limited Liability Company c.  Limited Liability Partnership d.  Corporation e.  Government entity f.  Other, please specify:______

8 Provide a history of the applicant.

9 Date of incorporation or organization

10 State of incorporation or organization

11 Nature of Business II. THE PROJECT:

1 Location of project

2 Nature of project

3 Provide a brief description of the project: a. Attach a detailed description of the project.

III. PROJECT INFORMATION

1 Description of real estate acquisitions or improvements to be financed (ie, land acquisitions, building improvements, etc.) if applicable:

2 Estimated hard or capital cost of land and/or improvements (ie, without engineering architecture, legal, and other professional expenses):

3 Estimated soft costs associated with acquisitions and/or improvements (ie, without engineering, architecture, legal, other professional expenses):

4 Location of acquisition or facilities to be improved:

5 Does applicant currently own land and/or facilities to be improved?

6 Owner of land and/or facilities if not applicant:

7 Does applicant currently lease land and/or facilities to be improved?

8 Current principal use of land or facilities to be improved:

9 Description of capital equipment (please provide cost for each item of equipment):

10 Estimate hard cost of capital equipment (please provide cost for each item of equipment):

11 Estimated soft costs associated with capital equipment (if any):

IV. PROJECT TIMETABLE:

1 Please describe the desired term of the financing (ie, length of repayment period) for each improvement and/or capital equipment:

2 Please provide the desired timetable for completion of the financing:

3 Please provide any key milestone dates and/or events relating to the project:

V. PROJECT CONSULTANTS Please provide the name, address and phone number of any professionals working on the project on behalf of the applicant as applicable:

1 Engineers:

2 Architects:

3 Contractors:

4 Attorneys:

5 Auditors/Accountants:

6 Other Consultants:

VI. OTHER INDEBTEDNESS

Please provide a detailed description of any other indebtedness of the applicant including bonds, leases, loans, etc., including amounts, terms of repayment, terms of optional redemption of early retirement, if any:

VII. EXPENDITURES

1 Have any expenditures been made to date or are any expenditures expected to be made toward the project prior to the completion of the financing (if so, please describe how much, on what dates, and for what purposes):

2 Does the applicant expect to reimburse itself for any or all of these prior expenditures?

3 Has the applicant adopted any declaration of intent to reimburse itself for any expenditure with the proceeds of a tax-exempt financing? (If so, please provide details):

VIII. PROJECT BENEFITS TO MERCER COUNTY

Please describe how the project will maintain or provide new employment for the people of Mercer County, maintain or increase the tax base of Mercer County and/or maintain, diversify and expand business and industry in Mercer County:

IX. PROJECT COSTS:

1 Total Project Cost: (include cost of issuing bonds) $______

2 Amount of Authority Bonds to be issued $______VI. PROJECT PURPOSE: (Identify the specific project purpose by checking appropriate box.)

 A. Provision of public facilities for use of state, county or municipality  B. Provision of a convention hall or other facilities for the accommodation and entertainment of tourists and visitors  C. Provision for public transportation or for terminal purposes  D. Provision of structures or facilities for aviation use  E. Provision of public facility for governmental and non-governmental uses  F. Acquisition of property from the United States of America  G. Acquisition, construction, maintenance and operation of garbage and solid waste disposal system  H. Improvement, furtherance and promotion of tourists and recreational attractiveness of the county including facilities for the recreation and entertainment of the public  I. Provisions of low and moderate income housing  J. Redevelopment projects  K. Provision of facilities for organization organized for any of the purposes set forth in N.J.S.A.15A:2-1(a)  L. Any combination of the foregoing (i) Specify

VII. FEE SCHEDULE (All payments made by applicant are non-refundable)

See Attached.

PLEASE NOTE: Eligibility for bond financing from the Mercer County Improvement Authority (the “Authority”) is determined by the information contained in this application, and its attachments and other information submitted by or on behalf of the applicant, and eligibility is further governed by the Improvement Authorities Act N.J.S.A.40:37A et seq. and applicable federal laws related to the issuance of tax-exempt bonds. Only the Authority, by resolution of the Members, can determine project eligibility and authorize the issuance of bonds.