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CWCB Construction Fund Loan Application <br />Lender Name & Address <br />Amount Pa ent Date <br />2• Are any of the above liabilities now in default, or been in default at any time in the past? yES <br />NO . If YES, please give detailed explanation. <br />�� <br />3. Please provide a suriunuq of all revenues received during the last two fiscal years by category <br />(such as service charges, tap fees, assessments, etc.). � �—° �' S `',�„�.t��.�%S n� <br />_`�%"�' l� l��tn� -�c �Cnuc o� '�l r37 �Z�c��� fisses�•-n�-�%�-s o� <br />� l %stiu,�e - �c��•.,.� o-� �1 / 3 �7 <br />4. Please provide a brief narrative description of sources of funding, in addition to the CWCB, which <br />have been e�cplored for this project (Exampies would be Banks, Rural Development, NRCS, <br />Colorado Water Resources and pov�,er Deye�opment Autl�rity, Colorado Division of Loca1 <br />Government, etc.). <br />5. What collateral will you be offering for this loan? Possibilities include the project itself, pledge oi <br />revenues, real estate, water rights. ___/„ �cr�s~� /r, �'�Q�zQ /ncsc� # l �>- <br />_ �'r� � iyl� �# � ��s�,� � o � �' <br />T'he above statements are true, to the best of my knowledge: <br />Signature of Applicant <br />By 1 � <br />Printed Name c'�v � "�', 1�,.7,�e j <br />Title ���' : 1 r �u ,;;.. <br />Date �/ � (� f � � <br />C:�.�o.� <br />4 <br />