Drawn On Reserve-Default-Replenishment Form
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Drawn On Reserve-Default-Replenishment Form. This is a California form and can be use in State Treasurers Office Statewide.
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CDIAC #
STATE OF CALIFORNIA
DRAW ON RESERVES/DEFAULT/
REPLENISHMENT* FORM
FOR MELLO-ROOS / MARKS-ROOS ISSUE
For office use only
Fiscal Year
Received
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
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: $
*Replenishment of Draw on Reserve (Voluntary Disclosure)
Date of Replenishment of Draw on Reserve:
Amount of Replenishment:
$
Comments:
Contact Information:
Filing Contact Name:
(Person filing Default/Draw on Reserve/Replenishment Report)
Agency/Organization Name:
Address:
City:
State:
Telephone:
Zip Code:
Fax Number:
E-mail Address:
Date of Filing:
11/2011
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