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CITY OF MOUNDS VIEW <br />INDUSTRIAL REVENUE BOND REQUEST FORM <br />1. <br />Company Name No. <br />_ ___Tel. <br />7 <br />Address <br />State of Incorporation <br />Contact Person <br />2. <br />Type of Business <br />j <br />Products or Services <br />S 3. <br />Site Location <br />4. <br />Nature of Project <br />5. <br />Current and Projected (5 years) Employment <br />Current Projected <br />Amount of Anticipated Payroll Increase <br />6. <br />Present Gross Earning or Sales of Company <br />7. <br />Projected Gross Earning or Sales of within: <br />Two Years Within 5 Years <br />8. <br />Size of Proposed Structure or Expansion Sq. Ft. <br />9. <br />Estimated Project Cost: Estimated Size of the issue. <br />Land <br />Buildings If the issue is less than <br />Equipment estimated project cost, <br />other indicate balance of <br />Special Utility Needs anticipated project funding. - <br />(water volume, waste <br />treatment, etc.) <br />TOTAL <br />10. <br />Estimated additional tax revenue from project <br />11. <br />Fiscal Consultant/Underwriter/Purchaser <br />Address <br />Contact Person Tel. No. <br />j 12. <br />Legal Counsel <br />Address !^ <br />Contact Person Tel. No. <br />