STATE OF CALIFORNIA MELLO-ROOS COMMUNITY FACILITIES DISTRICT (CFD) YEARLY FISCAL STATUS REPORT For Office Use Only California Debt and Investment Advisory Commission 915 Capitol Mall, Room 400, Sacramento, CA 95814 P.O. Box 942809, Sacramento, CA 94209-0001 Tel: (916) 653-3269 FAX (916) 654-7440 I. GENERAL INFORMATION A. Issuer B. Community Facilities District Number/Name C. Name/Title/Series of Bond Issue D. Date of Bond Issue E. Original Principal Amount of Bonds F. Reserve Fund Minimum Balance Required Fiscal Year ______________ CDIAC # ______________ ____________________________________________________ ____________________________________________________ ____________________________________________________ ____________________________________________________ $___________________________________________________ $___________________________________________________ II. FUND BALANCE FISCAL STATUS Balances Reported as of: A. Principal Amount of Bonds Outstanding B. Bond Reserve Fund C. Capitalized Interest Fund D. Construction Fund(s) June 30_______________ (Year) $ ___________________________________________________ $___________________________________________________ $___________________________________________________ $___________________________________________________ III. ASSESSED VALUE OF ALL PARCELS IN CFD SUBJECT TO SPECIAL TAX A. Assessed or Appraised Value Reported as of: $ ______________________ (Date) (Use Appraised Value only in first year of CFD or before annual tax roll billing commences) B. Total Assessed Value of All Parcels: $ _______________________ IV. TAX COLLECTION INFORMATION A. Total Amount of Special Taxes Due Annually $ ________________________ B. Total Amount of Unpaid Special Taxes Annually $ ________________________ C. Are the Special Taxes are Paid Under the County’s Teeter Plan. Yes No V. DELINQUENT REPORTING INFORMATION Delinquent Parcel Information Reported as of Equalized Tax Roll of: ___________________ (Date) A. Total Number of Delinquent Parcels: __________________________ B. Total Amount of Special Taxes Due on Delinquent Parcels: $______________________ (Do not include penalties, penalty interest, etc.) VI. FORECLOSURE INFORMATION FOR FISCAL YEAR (Aggregate totals, if foreclosure commenced on same date) Date Foreclosure Commenced Total Number of Foreclosure Parcels __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ Total Amount of Tax Due on Foreclosure Parcels $ $ $ $ $ ________________________________ ________________________________ ________________________________ ________________________________ ________________________________ (Attach additional sheets if necessary.) CDIAC (4/29/11) American LegalNet, Inc. www.FormsWorkFlow.com STATE OF CALIFORNIA MELLO-ROOS COMMUNITY FACILITIES DISTRICT (CFD) YEARLY FISCAL STATUS REPORT (Continued) VII. RETIRED ISSUES This issue is retired and no longer subject to the Yearly Fiscal Status report filing requirements. (Indicate reason for retirement) A. Matured Yes No If yes, indicate final maturity date: ________________________ B. Refunded Entirely Yes No If yes, state refunding bond title: __________________________ _________________________________________________________and issue date:__________________________ C. Other: _______________________________________________________________________________________________ VIII. NAME OF PARTY COMPLETING THIS FORM Name ___________________________________________________________________________________________________ Title ___________________________________________________________________________________________________ Firm/Agency _____________________________________________________________________________________________ Address ________________________________________________________________________________________________ City/State/Zip ____________________________________________________________________________________________ Phone No. ____________________________________________ Date of Report ______________________________________ Email: _______________________________________________ IX. ADDITIONAL COMMENTS: _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ Completion and submittal of this form to the California Debt and Investment Advisory Commission will assure your compliance with California State law. Section 53359.5 of the California Government Code requires that all agencies issuing Mello-Roos Community Facilities bonds after January 1, 1993 to report specific information to the Commission by October 30th of each year. CDIAC (4/29/11) American LegalNet, Inc. www.FormsWorkFlow.com