Form 1435 - Application For State Treasurer'S Approval To Issue Short-Term Municipal Securities

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Michigan Department of Treasury
This form is issued under the authority of P.A.
1435 (Rev 2-02)
34 of 2001. If your municipality does not have
qualified status, you must file this form to apply
Application for State Treasurer's Approval
for approval of the State Treasurer before
to Issue Short-Term Municipal Securities
Short-term Municipal Securities can be issued.
INSTRUCTIONS: Complete all parts of this application. The Department of Treasury may request additional information.
FILE WITH: Local Audit & Finance Division, Michigan Department of Treasury, P.O. Box 30728, Lansing, MI 48909-8228.
Direct questions to (517) 373-0660 or e-mail to Treas_MunicipalFinance@michigan.gov.
The municipality identified below applies for permission to issue short-term municipal securities under authority of P.A. 34 of 2001, as amended.
Legal Name of Municipality
County(ies)
Amount of Security
Issue Date
Due Date
Interest Rate
Year Borrowing Against
% Maximum
Current Fiscal Year
Next Succeeding Fiscal Year
Borrowing Against
Long-term
Operating Taxes
Capital Improvement Taxes
State Revenue Sharing
State School Aid
Municipal Securities
Grants
Purpose
TAX INFORMATION
Fiscal Year
Date Taxes Due
Date Taxes Delinquent
ELECTION INFORMATION
# of Mills
Date of
Date of Election
Expiration Date
Purpose*
Authorized
First Levy
*
Use language exactly as it appeared on the ballot or attach a copy of the ballot.
Name and Address of Bond Attorney
Telephone Number
(
)
Name and Address of Financial Consultant
Telephone Number
(
)
CERTIFICATION
I, the undersigned, certify that this application and the attachments were authorized by the governing body of this municipality, and that they are
complete and accurate in all respects.
Chief Administrative Officer Name and Title (Typed or Printed)
Chief Administrative Officer's Signature
Municipal Address
Telephone Number
Date
(
)

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