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<br />CWCB Construction Fund Loan Application <br /> <br />needed. <br /> <br />T ,ender Name & Address <br /> <br />Remaining <br /> <br />A mount <br /> <br />Annual <br />Payment <br /> <br />Maturity <br />Date <br /> <br />NONR <br />2. Are any of the above liabilities now in default, or been in default at any time in the past? <br />YES_NO _' If YES, please give detailed explanation. N/ A <br /> <br />3. Please provide a summary of all revenues received during the last two fiscal years by category <br />(such as service charges, tap fees, assessments, etc.). See attarhed revenue and eqJense <br />statement <br /> <br />4. Please provide a brief narrative description of sources of funding, in addition to the CWCB, <br />which have been explored for this project (Examples would be Banks, Rural Development, <br />NRCS, Colorado Water Resources and Power Development Authority, Colorado Division of <br />Local Government, etc.). None at this time <br /> <br />5. What collateral will you be offering for this loan? Possibilities include the project itself, pledge <br />of revenues, real estate, water rights. Water rights / ditrh and strnrtures <br /> <br />The above statements are true, to the best of my knowledge: <br /> <br />Signature of Applicant <br /> <br />By tL/~ .)J(f~ <br />Printed Name W !.En SAt t t <br />Title fRES/DeAlT <br />l/~to/ ()4 <br />I I <br /> <br />Date <br /> <br />C:\Projects\Market\CFLA902 <br /> <br />G:ICLlENTSIN\NEWLBICWCB CONSTRUCTIONFUNDLOANAPP.DOC <br /> <br />01126104 10:53 NA - <br /> <br />4 <br /> <br />CFLA902 <br />