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<br />CWCB Construction Fund Loan Application <br /> <br />Lender Name & Address <br /> <br />Remaining <br />Amount <br /> <br />Annual <br />Payment <br /> <br />Maturity <br />Date <br /> <br />None <br /> <br />2, Are any of the above liabilities now in default, or been in default at any time in the past? <br /> <br />YES NO X , If YES, please give detailed explanation, <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.), Listed on attached Financial Statements <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 <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. . A special assessment of $40,00 per share has alreadv <br />been instituted to pav for this proiect. Another additional $10.00 per share has been discussed <br />for future financial needs, Can also offer the proiect itself and a CD equal to one yearly <br />~:nt. <br /> <br />The above statements are true, to the best of my knowledge: <br />Signature of Applicant, . <br />By Jack Holman ~k,J ~~-a~ <br />Printed Name ,7:::" k /-I""'/?M d. '71. <br />Title Chairman <br /> <br />Date OS/21/03 <br /> <br />4 <br /> <br />CFLA602 <br />