STATE OF CALIFORNIA DRAW ON RESERVES/DEFAULT FORM FOR MELLO-ROOS / MARKS-ROOS ISSUE CDIAC # CALIFORNIA DEBT AND INVESTMENT ADVISORY COMMISSION 915 Capitol Mall, Room 400, Sacramento, CA 95814 P.O. Box 94809, Sacramento, CA 94209-0001 (916) 653-3269 FAX (916) 654-7440 For office use only Fiscal Year Received This form is submitted to the California Debt and Investment Advisory Commission in accordance with: (Please check one) Section 53359.5(c) of the California Government Code Mello-Roos Community Facilities Districts Default or Draw on Reserve Reporting. Section 6599.1(c) of the California Government Code Mark-Roos Bond Pooling Act Participants Default or Draw on Reserve Reporting Issuer: Bond Issue Title: CFD No: Project Name: Actual Sale Date: This filing reports a: (Please check one) Default Draw on Reserve Date Draw on Reserve or Default Occurred: Amount of Draw on Reserve: $ Amount not paid but due in the Default: $ Comments: Contact Information: Filing Contact Name: ______________________________________________________________ (Person filing Default/Draw on Reserve Report) Agency/Organization Name: ________________________________________________________ Address: ________________________________________________________________________ City: ______________________________________________ State: ____ Zip Code: __________ Telephone: ________________________________________ Fax Number: __________________ E-mail Address: __________________________________________________________________ Date of Filing: ________________________________________ Created on 1/28/99 Updated: 1/11/01 American LegalNet, Inc. www.FormsWorkFlow.com