Form BIA-ARRA1 APPLICATION FOR ALLOCATION OF TAX CREDIT BONDS FOR BIA-F

BIA-ARRA1 OMB Control No. 1076-XXXX

Expiration Date: MM/DD/YYYY

APPLICATION FOR ALLOCATION OF
TAX-CREDIT BONDS FOR BIA-FUNDED SCHOOLS

Department of the Interior

Office of Facilities, Environmental and Cultural Resources

Attention: Bernadette Myers

2051 Mercator Drive

Reston, Virginia 20191

Dear Madam:

The following constitutes the application (“Application”) of (Name) (the “Applicant”) for allocation of tax-credit bonds pursuant to Title I, § 1521 of the American Recovery and Reinvestment Act to finance the project described below. (If a single Application is used to request tax-credit bonds for more than one project, then all of the required information in the Application must be provided separately for each project.)

1. Name of Applicant/Issuer_________________________________________________

Street Address ___________________________________________________________

City__________________________State_______________________Zip____________

Telephone Number _______________________ Fax Number _____________________

EIN

2. Status of Issuer – (Select as appropriate)

The Applicant/Issuer is a “qualified issuer” under § 7871(f) because it is --

(i) an Indian tribal entity that appears on the most recent list published by the Department of Interior in the Federal Register pursuant to the Federally Recognized Indian Tribe List Act of 1994, Pub. L. 103-454, 108 Stat. 4791 (“List”), as demonstrated by the attached documents included as Exhibit A.

(ii) an Indian tribal government which is acknowledged as a federally recognized Indian tribe, as stated in a letter from the Department of the Interior, as demonstrated by the attached documents included as Exhibit A.

3. Name of Project

4. Detailed Description of the Project. A reasonably detailed description of the facility to be financed (the “Project”) is set forth below or in attached Exhibit B.

If the Project is a joint Project, please describe in detail the other owners of the project and the applicant’s ownership interest in the project.

5. Construction Commencement Date and Placed in Service Date. The Applicant begun or expects to begin the construction, installation and equipping of the Project on ______________________. The Applicant expects that the Project will be placed into service on or before _________________.

6. Pool Issuances. Does the Applicant expect to have the tax-credit bonds issued by a pool issuer or an “on behalf of issuer”?

If the answer above is yes, please describe the pool issuer or on behalf of issuer and provide a statement that the pool issuer is an Indian tribal government or that the “on behalf of issuer” meets the requirements to be such an issuer under the rules applicable to bonds in accordance with current IRS regulations.

6. Location of the Project:

Project address or physical location (do not include postal box numbers or mailing address)

City State Zip            

Reservation where Project will be located:___________________________________

Include in the attached Exhibit C, a certification that the Project will be located on the Applicant’s reservation. If the tax-credit bonds will be issued for a joint project please include in attached Exhibit C a certification that the Project will be located on a reservation of at least one of the Indian tribal governments receiving an allocation with respect to such Project.

6. Individual to contact for more information about the Project:

Individual Name

Company Name

Street Address

City State Zip                    

Telephone Number ____________________________

Fax Number __________________________________

Email Address __________________________________

6. Regulatory Approvals. Identify each regulatory body, the action that must be taken, status of any pending action and the remaining timeframe required to obtain each required approval. The plan of the Applicant for obtaining such approvals is as follows: (or attach an Exhibit)

7. Plan of Financing. Include a reasonably detailed description of the plan of financing for the Project, including all reasonably expected sources and uses of financing and other funds, the status of such financing, the anticipated date of bond issuance, the sources of security and repayment for the bonds, the aggregate face amount of bonds expected to be issued for the Project, and the issuer’s reasonably expected schedule for expending the proceeds of the tax-credit bonds. Attached as Exhibit D is a plan of financing for the Project.

8. Statement of Readiness.

   1. Application from the First Allocation. Include in Exhibit E a statement signed under penalties of perjury that the Issuer reasonably expects to issue bonds pursuant to the requested allocation within six months of the authorization.

   2. Application from the Second Allocation. Include in Exhibit E a statement signed under penalties of perjury that the Issuer reasonably expects to issue bonds pursuant to the requested allocation within six months of the authorization.

9. Dollar Amount of Allocation Requested for the Project. To finance the Project, the Applicant hereby requests a tax-credit bond allocation in the amount of $___________________.

10. Prior Allocations for the Project. (If the Project or any Related Project (as defined in section 7.b.(2) of this Notice) previously received a tax-credit bond allocation, then this paragraph must include a statement to that effect.) [If applicable, include the following statement: On (Insert date), the Project previously received a tax-credit bond allocation in the amount of $_______________. A copy of the Indian Affairs allocation letter for that allocation is attached.]

11. Assignment of allocations to another issuer. (If the applicant expects to assign its allocation to another qualified issuer of tax-credit bonds as authority for the tax-credit bond issuer to issue bonds for the project on behalf of the applicant, the applicant should provide the following statement:))

The Applicant expects to assign the requested allocation for tax-credit bonds to a qualified issuer of tax-credit bonds as authority for the tax-credit bond issuer to issue bonds for the project on behalf of the Applicant. Applicant agrees to obtain a written commitment from the assignee tax-credit bond issuer that it is a qualified issuer of tax-credit bonds and that it will issue tax-credit bonds for the project within the time frame specified in the Application for the Applicant’s bonds.

6. Penalty of Perjury Statement and Signatures

I hereby certify that I am an authorized officer or official of the Applicant, that I am duly authorized to execute legal documents on behalf of the Applicant in connection with incurring debt, and that I am duly authorized to execute legal documents on behalf of the Applicant in making this Application. Under penalties of perjury, I declare that (i) I have knowledge of the relevant facts and circumstances relating to this Application and the Project(s), (ii) I have examined this Application, and (iii) to the best of my knowledge and belief, all of the facts contained in this Application are true, correct and complete.

By: ____________________________________

Name: ____________________________________

Title: ____________________________________

Date: ____________________________________

Paperwork Reduction Act Statement: This information is required to obtain a benefit. It is estimated that responding to the request will take an average of 40 hours to complete. This includes the amount of time it takes to review instructions, gather and maintain the data needed, and complete and submit the form. In compliance with the Paperwork Reduction Act of 1995, as amended, this collection has been reviewed by the Office of Management and Budget and assigned a control number and expiration date. The control number and expiration date are at the top right corner of the form. Please note that an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless there is a valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Office of Facilities, Environmental, and Cultural Resources, Office of the Assistant Secretary-Indian Affairs, U.S. Department of the Interior, 2051 Mercator Drive, Reston, Virginia 20191. Note: comments, names, addresses, phone numbers, e-mail addresses, or other personal identifying information of commenters may be made publicly available at any time. While commenters can ask to withhold personal identifying information from public review, the Department cannot guarantee that it will be able to do so.

Exhibit A

Documents regarding issuer Status as an Indian tribal government
(response to Question 2 of the Application)

(Attached hereto)

Exhibit B

Description of the Project
(response to Question 4 of the Application)

(Attached hereto)

Exhibit C

Project location on indian tribal government reservation

(response to question 7 of the application)

Exhibit D

Plan of Financing
(response to Question 10 of the Application)

(Attached hereto)

Exhibit E

Statement of Readiness to Issue
(response to Question 11 of the application)

I hereby certify that I am an authorized officer or official of the Applicant, that I am duly authorized to execute legal documents on behalf of the Applicant in connection with incurring debt, and that I am duly authorized to execute legal documents on behalf of the Applicant in making this Application. Under penalties of perjury, I declare that the Applicant reasonably expects that bonds issued pursuant to the tax-credit bond allocation to be received will be issued within six months of authorization.

By: ____________________________________

Name: ____________________________________

Title: ____________________________________

Date: ____________________________________

APPENDIX B

CONSENT TO PUBLIC DISCLOSURE

OF CERTAIN TAX-CREDIT BOND

APPLICATION INFORMATION

In the event that the Application of [ ____________________________] (the “Applicant”) for an allocation of authority to issue Tax Credit Bonds to be used for the purpose of the construction, rehabilitation, and repair of schools funded by the Bureau of Indian Affairs (“Tax-Credit Bonds”) is approved, the undersigned authorized representative of the Applicant hereby consents to the disclosure by Department of the Interior through publication of a Notice or a press release of the name of Applicant (issuer), the type and location of the facility that is the subject of the Application, and the amount of the tax-credit bond allocation for such facility. The undersigned understands that this information might be published, broadcast, discussed or otherwise disseminated in the public record.

This authorization shall become effective upon the execution hereof.

I certify that I have the authority to execute this consent to disclose on behalf of the Applicant named below.

Date: __________________ Signature: _________________________

Print name: _________________________

Title: _________________________

Name of Applicant: ___________________________________

Applicant’s Mailing Address: ___________________________________

___________________________________