DRP 1002 Revised 012/04/08

DEPT. OF LOCAL GOVERNMENT FINANCE

POST LEASE EXECUTION

INFORMATION SHEET

This form must be filed with the DLGF prior to December 31 of the yearof lease execution.

Unit Number: Unit Name:

County: Petition Number (if applicable):

I. Requesting approval of

Select One:

Total final project cost (hard and soft costs):

For a project involving lease rental payments, please provide:

Term of the Lease: Maximum annual rental payment:

II. Project DeTAIL

Describe the use of Lease proceeds:

Date construction started for meeting the objectives of the project:

Date the bids were received:

Describe any changes made to the project after DLGF approval (if approval was necessary):

III. Lease information

Date of hearing on lease rental agreement:

Date when lease rental agreement was executed:

Date Notice to Taxpayers of Execution of Lease was published:

Last date an objecting petition may be filed on the lease:

(Submit copies of all proofs of publication pertaining to this project)

What is the name of the Holding Corporation:

Please list the names of the holding corporation officers and their relationship to the Unit of Government.

If the Unit of Government is using a holding corporation, is the lease rental agreement with a non-profit holding corporation?

Will the lease rental payments be used as debt service payments for bonds issued by the holding corporation?

If the lease rental payments will not be used as debt service payments, please do not answer the following five (5) questions:

1) Date that bonds were sold:

2) Which manner of bond sale was selected?

3) What is the par value of the bonds?

4) How many bonds were issued?

5) What is the interest rate of the bonds? %

IV. SCHEDULE OF MATURITIES AND INTEREST

Payment Date (mm/yy) / Principal
Balance / Principal Paid / Interest Rates (%) / Debt Service Interest / Total Debt Service / Trustee Fee
Column Totals / 0 / 0 / 0 / 0

V. Project Cost Analysis (Total Project Costs)

Cost of Construction / Holding Corp / Const Fund / CPF / Total Cost
Construction Costs: 0% / 0

Construction Mgt.: 0%

/ 0
Clerk of the Works: 0% / 0
Contingencies/Gen. Cond: 0% / 0
Total Construction Cost: 0% / 0 / 0 / 0 / 0

Professional Fees

Architect Fees:0%

/ 0

Architect Reimbursable

/ 0

Ext. Architects Fees: 0%

/ 0

Soil Testing & Surveys:

/ 0

Total Professional Fees: 0%

/ 0 / 0 / 0 / 0

Land, Building & Equipment

Land Cost:

/ 0

Building Cost/Demolition:

/ 0

Loose Equipment:

/ 0

Technology Equipment:

/ 0

TotalLand, Bldg., Equip.: 0%

/ 0 / 0 / 0 / 0

Other Project Costs

Builders Risk Insurance:

/ 0

Title Insurance:

/ 0

Other:

/ 0

Total Other Project Costs: 0%

/ 0 / 0 / 0 / 0

TOTAL COST: 0%

/ 0 / 0 / 0 / 0

Cost of Financing

Attorney Fees:* 0%

/ 0

Bond Counsel:* 0%

/ 0

Financial Advisor:*0%

/ 0

Underwriter's Fees:*0%

/ 0

Trustee Fees:*0%

/ 0

Off. Statement & Ratings:

/ 0

Bond Printing:

/ 0

Legal Advertising:

/ 0

Capitalized Interest:

/ 0

Other:

/ 0

Interest During Construction

Months @ 0.00% / 0

Total Financing Costs: 0%

/ 0 / 0 / 0 / 0

Total Project Cost:

/ 0 / 0 / 0 / 0
* = expressed as a percentage of total financing costs

Please submit the completed information sheet (in electronic format) via email to the Data Analysis Division at or by mail to:

Data Analysis Division

Department of Local Government Finance

100 North Senate Avenue, Room N1058

IndianapolisIN46204

Department of Local Government Finance Post Lease Execution Information Sheet - Page 1