4.5. SR 02-06-2012 - Laserfiche WebLink

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Form 9038-G {Rev, 9-2011) 35 36a b c 37 38a b G d 39 40 41a b c d 42 °~ 43 ~~ 45a b Page 2 aneous Enter the amount of the state volume cap allocated to the issue under section 141(b)(5) 35 Enter the amount of gross proceeds invested or to be invested in a guaranteed investment contract (GIC) (see instructions) 36a Enter the final maturity date of the GIC - Enter the name of the GIG pravider - Pooled financings: Enter the amount of the proceeds of this issue that are to be used to make loans to other governmental units • 37 _ If this issue is a loan made from the proceeds of another tax-exempt issue, check box - ^ and enter the following information: Enter the date of the master pool obligation - __ Enter the EIN of the Issuer of the master pool obligation - Enter the name of the issuer of the master pool obligation - If the issuer has designated the issue under section 265(b}{3)(B)(i}(III) (small issuer exception), check box M If the issuer has elected to pay a penalty in lieu of arbitrage rebate, check box - If the issuer has identified a hedge, check here - ^ and enter the following information: Name of hedge provider- ~~, _,,,,_- Type of hedge - __._~_ Term of hedge - If the issuer has superintegrated the hedge, check box . - If the issuer has established written procedures to ensure that all nonqualified bonds of this issue are remediated according to the requirements under the Code and Regulations (see instructions), check box - if the Issuer has established written procedures to monitor the requirements of section 148, check box . - If some portion of the proceeds was used to reimburse expenditures, check here - ^ and enter the amount of reimbursement . - -.,,o_, Enter the date the official intent was adopted - m Under penakies of penury, I declare that I have examined this return and accompanying schedules and statements, and to the best ofmy knowledge Signature and belief, they are true, correct, and complete. I further declare that I consent to the IRS's disclosure of the issuer's return information, as necessary to and process this return, to the person that 1 have authorized above. Consent \ ~. ______________..__ Signature of issuer's authorized representative Date ~ T'ype or print' name and title Paid Print/Type preparer's name Preparer's signature Date PTIN Check ^ if Preparer self-employed Use Onl Firm s name - ! Firm s EIN - ~. ~ -m..v -.. -d- e ,H_~ _ ~ ___ _- Form t3U:iti-(9 (Rev, 9-2011)