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280666 v WHITE - C�TV CLERK AINK T�INANCE G I TY O F SA I NT PA U L Council ���,� �-�� CANARV - DEPARTMEN T BLU° - MAVOR File NO. r''�` �� ' � . C r�c 'l Resolution Presented By � - � Referred To Committee: Date Out of Committee By Date RESOLUTION RECITING A PROPOSAL FOR A FINANCING PROGRAM FOR A MULTI-FAMILY RENTAL HOUSING DEVELOPMENT, GIVING PRELIMINARY APPROVAL TO THE PROJECT AND THE PROGRAM PURSUANT TO MINNESOTA STATUTES, CHAPTER 462C, AUTHORIZING THE HOUSING AND REDEVELOPMENT AUTHORITY TO ISSUE HOUSING REVENUE BONDS AND AUTHORIZING THE SUBMISSION OF FINANCING PROGRAM FOR APPROVAL TO THE MINNESOTA HOUSING FINANCE AGENCY AND AUTHORIZING THE PREPARP,TION OF NECESSARY DOCUMENTS AND MATERIALS IN CONNECTION WITH THE SAID PROJECT AND PROGRAM ' (FOREST PLACE PROJECT) WHEREAS, (a) Minnesota Statutes, Chapter 462C (the "Act) authorizes cities, or housing and redevelopment authorities, port authorities authorized by ordinance to exercise on behalf of a city the powers conferred by the Act, the power to issue revenue bonds to finance a program for the purposes of planning, administering, making or purchasing loans with respect to one or more multi-family housing developments within the boundaries of the city; COU[VCILMEN Requested by Department of: Yeas Nays Fletcher �e��� In Favor Masanz — Nicosia scheibei __ Against BY Tedesco Wilson Form Approved by City Attorney Adopted by Council: Date ���'s�NO�/�-� Certified Passed by Council Secretary BY sy Approved by Nlavor: Date _ Approved by Mayor for Submission to Council By - BY . . � .���,���� (b) The Housing and Redevelopment Authority of the City of Saint Paul, Minnesota (the "HRA") has been designated, by ordinance, to exercise, on behalf of the City of St. Paul, Minnesota (the "City" ) the powers conferred by Minnesota Statutes, Section 462C.01 to 462C.08; (c) The City has received from Forest Place Limited Partnership of St. Paul, a Minnesota limited partnership to be formed by David Ames (the "Developer") a proposal that the City undertake a program to finance a Project hereinafter described, through the issuance of revenue bonds (which may be in the form of a single debt instrument) (the "Bonds" ) pursuant to the Act; (d) The City desires to: facilitate the development of rental housing within the community; encourage the development of affordable housing opportunities for residents of the City; encourage the development of housing facilities designed for occupancy by persons of low or moderate income; and prevent the emergence of blighted or underutilized land and structures within the boundaries of the City; and the Project will assist the City in achieving these objectives. (e) The Developer is currently engaged in the business of real estate development. The Project to be financed by the Bonds is the acquisition, construction and equipping of multi-family rental housing and consists of the acquisition of land and the construction of buildings thereon and the installation of equipment therein, that will result in the provision of additional rental housing opportunities to persons withi.n the community; ' . , '� . ������h� (f) The City has been advised by representatives of the Developer that con- ventional, commercial financing to pay the capital costs of the Project is available only on a limited basis and at such high costs of borrowing that the economic feasibility of operating the project would be significantly reduced, but the Developer has also advised the City that with tYie aid of municipal financing, and resulting low borrowing costs, the Project is economically more feasible; (g) A public hearing on the Project and the financing program therefor was held on July 28 , 1983, after notice was published, as required by Minnesota Statutes, Section 462C.05, subd. 5, at which public hearing all those appearing at said hearing who desired to speak were heard; (h) No public official of the City has either a direct or indirect financial interest in the Project nor will any public official either directly or indirectly benefit financially from the Project; (i) The Developer has submitted to the City a form of Memorandum of Understanding executed by the Developer, expressing certain understandings by and between the City and the Developer pertaining to the Project, and the financing therefor. NOW THEREFORE, BE IT RESOLVED by the City Council of the City of Saint Paul, Minnesota, as follows: 1. The City hereby gives preliminary approval to the proposal of the Developer that the City undertake a Project, and the program of financing therefor, pursuant to Minnesota Statutes, Chapter 462C, consisting of the acquisition, construction and equipping of multi-family rental housing facilities within the City pursuant to the Developer' s specifications and to a revenue agreement between the City and the Developer on such terms and conditions with provisiona for revision from time to ti.me as necessary, so as to produce _ '. �' ,�fi �, ����� income and revenues sufficient to pay, when due, the principal and interest on the Bonds in the total principal amount of approximately $3,000,000 to be issued pursuant to the Act to finance the acquisition, construction and equipping of the Project; and said agreement may also provide for the entire interest of the Developer therein to be mortgaged to the purchasers of the Bonds, or a trustee for the purchasers of the Bonds;, and the City hereby undertakes preliminarily to issue its bonds in accordance with such terms and conditions; 2. On the basis of information available to the City it appears, and the City hereby finds, that the Project consti- tutes a multi-family housing development within the meaning of subdivision 5 of Section 462C.02 of the Act; that the Project will be primarily occupied by persons of low or moderate income; the availability of the financing under the Act and the willingness of the City to furnish such financing will be a substantial inducement to the Developer to undertake the Project, and that the effect of the Project, if undertaken, will be to encourage the provision of additional multi-family rental housing opportunities to residents of the City, to assist in the prevention of the emergence of blighted and marginal land and to promote more intensive development and use of land within the City; 3. The Project, and the program to finance the Project by the issuance of revenue bonds, is hereby given preliminary approval by the City subject to the approval of the financing program by the Minnesota Housing Finance Agency ( "MHFA") and subject to final approval by the City, the Developer and the purchasers of the Bonds as to ultimate details of the financing of the project; 4. Pursuant to Chapter 72, Saint Paul, Minnesota, Aministrative Code, the City hereby authorizes and directs the Housing and Redevelopment Authority of the City of Saint Paul, Minnesota (the "HRA" ) to issue the housing revenue bonds to finance the Project and to take all actions necessary or desirable in connection therewith, and no further approval or authorization of the City shall be required; 5. In accordance with subdivision 5 of Section 462C.05, Minnesota Statutes, the Mayor of the City is hereby authorized and directed to submit the program for financing the project to MHFA, requesting its approval, and other officers, and employees and agents of the City and HRA are hereby authorized to provide MHFA with preliminary information as it may require; , , . ,����.���� 6. The Developer has agreed and it is hereby determined that any and all costs incurred by the City or HRA in connection with the financing of the Project whether or not the project is carried to completion and whether or not approved by NII3FA will be paid by the Developer; 7. Briggs and Morgan, Professional Association, is hereby retained as bond counsel for the Bonds, and such firm, acting as bond counsel, is authorized to assist in the preparation and review of necessary documents relating to the Project and the financing program therefor, to consult with the City Attorney, Developer and purchasers of the Bonds (or trustee for the purchasers of the Bonds) as to the maturities, interest rates and other terms and provisions of the Bonds and as to the covenants and other provisions of the necessary documents and su�nit such documents to the City for final approval; 8. Nothing in this Resolution or the documents prepared pursuant hereto shall authorize the expenditure of any municipal funds on the Project other than the revenues derived fran the Project or otherwise granted to the City or HRA for this purpose. The Bonds shall not consitute a charge, lien or encumbrance, legal or equitable, upon any property or funds of the City or HRA except the revenue and proceeds pledged to the payment thereof, nor shall the City or HRA be subject to any liability thereon. The holder of the Bonds shall never have the right to compel any exercise of the taxing power of the City or HRA to pay the outstanding principal on the Bonds or the interest thereon, or to enforce payment thereon against any property of the City or HRA. The Bonds shall recite in substance that Bonds, including the interest thereon, are payable solely from the revenue and proceeds pledged to the payment thereof. The Bonds shall not constitute a debt of the City or HRA within the meaning of any constitutional or statutory limitation. 9. In anticipation of the approval by MHFA and the issuance of the Bonds to finance all or a portion of the Project, and in order that completion of the project will not be unduly delayed when approved, the Developer is hereby authorized to make such expenditures and advances toward payment of that portion of the costs of the Project to be financed from the proceeds of the Bonds, as the Developer considers necessary, including the use of interim, short-term financing, subject to reimbursement from the proceeds of the Bonds if any when delivered but otherwise without liability on the part of the City or HRA. � WHITE - C�TV CLERK PINK -"FINANCE (1� `��„'� �:.ANAR\~- DEPARTMEN T G I TY OF SA I NT PA U L COUIICII �) � ��T Bl.liE - MAVOR File NO. �� J � J �� Council Resolution Presented By Referred To Committee: Date Out of Committee By Date 10. Subject to the approval of the City Attorney, =the form of the Memorandum of Understanding and Exhibit thereto are hereby approved. The Memorandum of Understanding is authorized and directed to be executed in the name and on the behalf of the City by the Director, Department of Planning and Economic Development upon execution thereof by the Developer. Pursuant to the terms of the Memorandum of Understanding and paragraph 4 hereof, all the rights, duties and privileges of the City under the Memorandum of Understanding are hereby transferred and assigned to the HRA. �i - COUfVCILMEN Reque ed by Department of: Yeas p�etcher Nays � ��� '�"'� [n Favor Masanz � Nicosfa �� schetbe� Against BY� -'�%G(�"'� � Tedesco Wilson Adopted by Council: Date JtlL 2 8 1983 Form Approved by City Attorne Certified P ss d y ouncil S t By `l��i'��ifTi�[..V . ' By � �lpprov Ylav o UL 2 9 1983 App ov d, y Mayor for Submis ' 1n t Counc' BY �By , � . PUBLISNEO AU G 6 1983 �- � w� � � . . � � ������/� �- I�OU3!!�� _;� REDEYELOP�VIEN�' l��.�i HORiTY OF TNf CITY 0� SAINT PAUL, MINNESOTA - REPOS����COMM�8Sf0aER3 QATE luly 1, t9$� - . RE6ARti�l�i DESIGNATION OF TENTATIVE DEVELOPER FOR PARCEL 48-A/ ST. THERESA SITE AND AUTHORIZATION TO SCHEDULE HEARING BEFORE COUNCIL - MULTIFAMILY RENTAL HOUSING REVENUE BOND PROGRAM Dav���e�eveloper, has requested tentative developer designation for the abosres�ll�5?�:de�elop 60 units of rental housing. The District 6th Land Use Com�t �s�•recomending approval by the District 6th Planning Coun�il who meets��'. 3 This site has not been developed for many years due to serious advec,���nditions. The developer will require tax exempt revenue bond financing . and �rs��'e some tax increment financ:�; to correct these soii conditions. The finar�,�pDariuis being reviewed and negotiated by Staff. A full report will be submitted wh�t� ara�e resolved. :Sta�#s�quesfss(Commissioner approval of the attached resolution naming David Ames as ter�tative d�veloper for 120 days. Staff further requests approval of a second resolution autt�r�zing St�:ff to request a public hearing by the City Council for submission of a fi�lg p�qgram to MHFA. Additionally Staff recommends that Piper, Jaffray, and ��o�rwoo�tbe designated as underwriters and that Briggs and Morgan be designated as Band Cour�l. .. Ken Gauthiec � l ���,L1�'�� rs � . . . , � . � ��r�:f�A�t���3 . � r d• • • • • �strict six p ann�n Ci�(,�n�i�) 1021 Marion St., St. Paul, Mn 55117 . r-- � � Ken Gauthier � '�� � � City of St. Paul v y;.���jF 25 W. 4th Street � � St. Paul, Mn. 55102 =� d��24 ?98� 2 ; � � PR0.1�C7- y� ,� � �A'VAGE�F�? June 23, 1983 L ��� a � F.e : St. Therese Site-Parcel 48 A Dear Mr. Gauthier, I an writing on behalf of the District Six Planning Coun.cil � I,and Use iask Force. June 22, 1983 the I,and Use Task Force approved the site plan . _ -_ _ forwarded by David Ames and presented by district staff. If any changes occur the I,and Use Task Force requests that they be informed. In reviesving the Developmenti Con�rols and �bjectives t;ha�t � � esented to the I,and Use Task Force previously regarding were pr this site it reads-: The primary objective of this residential development is to crea�e housing that is compatible in scale and design with the surrounding residential buildings, while preserving as much of the existing vegetation as possible. I included this because a few of the task force members made statements regarding that site being the only real wooded or "existing vegetation" in the area. The District Six Planning Council will review this in July. • cerely, � on oyda . s��• . � ��� , ,� � , ' '_" ��� F ' 83 - � I � - �, . ; RESOLUTION CALLING FOR A PUBLIC HEARING ON A PROPOSAL FOR A PROGRAM FOR A MULTI-FAMILY HOUSING DEVELOPMENT ON F�'JREST PLACE AND DESIGNATING AN UNDERWRITER FOR INVESTMENT BANKING SERVICES AND BOND COUNSEL FOR THE PROGRAM . WHEREAS, Minnesota statues, chapter 462C (the "Act") gives cities, or housing and redevelopment authorities, on behalf of the city, the powers conferred by the Act, the power to issue revenue bonds for the purpose of planning, administering, making or pur�hasing loans to finance one or more multi-family housing developments within the boundaries of the city; �- - WHEREAS, the city has received from David Ames (the "Developer") a proposal that the city undertake a program to finance a multi-family housing development by the issuance of its revenue bonds pursuant to the Act; WHEREAS, the city desires to facilitate the development of rental housing within the community; WHEREAS, before proceeding with consideration of the request of the Developer it is necessary for the HRA to request the holding of a public hearing by the City Council pursuant to the Act, designating an Underwriter for investment - banking services and a Bond Counsel for the project, and authorizing continuing negotiations with the Developer; NOW, THEREFORE, BE IT RESOLVED by the Housing and Redevlopment Authority of the City of Saint Paul, Minnesota as follows: � 1 aJ . - . . . • • !`r'a3!,���� . l. A public hearing by the City Council to consider authorizing submission for approval to the MHFA of a financing program purusuant to MSA Chapter 462C will be held at the time and place set forth in a Notice of Hearing to be published by the Clerk of the City. � 2. Piper, Jaffray, and Hopwood, Inc. is designated as underwriter for the multi-family (rental) housing development program for investment banking services. 3. Briggs and Morgan, Proffessional Association is designated as Bond Counsel � for the multi-family (re�tal) hausing development program. 4. Staff is directed to continue negotiations with the Develaper, Underwriter, Bond Counsel and Lender for the hous�.�g program. ., . .. _ . � .���i�'��t�� �-:� i`:�Y�� RESOLUTIO;� N0. 83-7/6-� � `;.� RESOLUTION AUTHORIZING DESIGNATION OF A TENTATIVE DEVELOPER FOR PARCEL i Ui�1BER 48-A (ST. THERESA SITE, NORTH END DISTRICT 6) NEW HOLSING AND BLIGHTED LANDS DEVELOPME�T PROJECT r k�"'���.`� , the Department of Planning and Economic Develo�ment and the ��zusing and Redevelopment Authority of the City of Saint Pau�, ��nesota (HRA/PED) advertised Parcel 48-A (St . Theresa Site) for Se�e��on 8 Multi-Family Housing Development in February and _ i�larch, ��81, with all proposals due by March 20, 1981 ; and i;;�'tEAS , at the conclusion oi the advertisement period three proposa�ts 'thad been received, and a tentative developer was designated by the ?i�ard� on April 22 , 1981 for ninety (90) days ; and � , at the end of the tentative developer period , no firm � proposa� ha:s been received, Minnesota Housing Finance Agency refused to fi�ee �-i.te for Section 8 due to its poor soil condition and costly �ex-�e�se to correct for development ; and ._, �RE� , as a consequence of these conditions the St . Theresa "'' Site was maF:�e part of the New Housing And Blighted Lands Development ProjQCt; zn� �RE� , staff has been soliciting developers for this site since the aa3vertising period tiaithout success in securing a feasible develo�ent n and i��RE� , HR.A ha� been apprcached by David Ames , an indi��idt al , who has ree�aiested tentative developer designation �or the above site on which. to develop 60 units of rental housing; and � t,iHERE�S , staff and developer have conversed with the District 6 Planning Council who will be recommending to their full Council approval o€ this request and development ; and �'HEREAS , the developer will require tax exempt revenue bond � financing and may require some tax increment f�nancing to correct these sail conditions , all financing terms will be submitted to the �o2rd at a later date ; and �r-^ �• n�REAS , this site has not been developed for three (3) years due to serious adverse soil conditions , and expense is increasing -� =o riaintain the site , staff recommends approval of this tentati��e �,"� c�-�elo�er designation . ��'� BE IT RESOLVED by the Housing and Redevelopment :�0'ti', THEREFORE , ..�:::: ��r��y of the City of Saint Paul , ^�innesota , that David I•1. Ames , i .., .. _ _ _. _ . ,������,� �:- a:� =r�da�=��l�a1 , be named tentative developer of Parcel 48-A � (St . T�s�� Site) , North End District 6 , for a period of one _ hundre� �nty (120) days in which to secure the necessarX fina�c� a�nd complete all required documentation in order to con��t� the sale an3 proceed with construction in accordance �•�ith t�e R��:development Plan for the New Housing And BTighted Lands i3��z��:7lropment Pro i ect . . .�� :;: �_ .� � � t � �I�. � � >j�•(, �w =;;,;+3��,'�3�#,y`;a •.�,a FJLEO CITY OF SAINT PAUL ��}Z � INTERDEPARTMENTAL MEMORANDUM � f' ���� �3 GIT� CLE^1��g pFFtCr• r� a .11 F;;ti�� kfi;,:.�PI, �. DATE: July 7, 1983 T0: A1 Olson, City Clerk FROM: Sheri Pemberton, PED �� SUBJECT: City Council Public Hearing For July 28, 1983 Attached is a Copy of the Public Hearing Notice, which will be published in the St. Paul Legal Ledger and the St. Paul Pioneer Press and Dispatch on Saturday, July 9, 1983. This Public Hearing Notice meets the fifteen (15) day requirement for issuance of Revenue Bonds. Please place this Public Hearing on the City Council Agenda for Thursd�y, July 28, 1983. A City Council Resolution will be forwarded to you by the City Attorney's Office prior to. the City Council meeting. Thank you. SAP:sp cc: Ken Gauthier Beck Hartman Chron Parcel , - ������ D(� °' CITY OF SAINT PAUL ¢6`'TY °'@ DEPARTMENT OF PLANNING AND ECONOMIC DEVELOPMENT o �a �iVISION OF DEVELOPMENT a �u1t111111 ro 25 West Fourth$treet,Saint Paul,Minnesota 55102 � utt i ll II � 612 292 1577 � ^ �sa• GEORGE LATIMER MAYOR St. Paul Legal Ledger July 7, 1983 Publication Office 640 Minnesota Bldg. St. Paul, MN. 55101 RE; LEGAL NOTICE Gentlemen: Attached is a Notice of Public Heaxing on a PYOposal for a Program to Finance a Multi-Family Rental Housi:ng Development. Please publish this Notice in the St. Paul Legal Ledger for Saturday, July 9, 1983. If you have any questions concerning this publication, please contact me at 292-1577, extension 231. Sincerely, �4a. -�.��.�'�� �� Sheryl A. Pemberton Real Estate Supervisor Enclosure � . ������; CITY OF SAINT PAUL �`lTr '' DEPARTMENT OF PLANNING AND ECONOMIC DEVELOPMENT ;� �a DIVISION OF DEVELOPMENT � n�111111n , 25�West Fourth Street,Saint Paul,Minnesota 55102 � n�� t lt n ho 612 2921577 0 I�p♦ GEORGE LATIMER MAYOR St. Paul Dispatch and Pioneer Press July 7, 1983 55 East Fourth Street St. Paul, Mn. 55�.01 Attention: Rosemary Frank RE: LEGAL NOTICES Gentlemen: Listed below axe four Notices for publication on Saturday, July 9, 1983, and are as follows: 1.) NOTICE QF PUBLIC HEARII�IG UPON PRG�P75ED SALE OF CERTAIN PARCELS OF LAND; and 2.) NOTICE OF PUBLIC HEARING UPON PROPOSED REDEVELOPER'S AGI2EEMENT FOR TROUT BROdK REDEVELOPMENT PROJECT, PHASE I; and 3,) NOTICE OF PUBLIC DISCLOSURE ON CONTRACT FOR SALE BY THE HOUSING :1ND REIIEVEIAPMENT AUTFT.OF.I^.'Y OF THE CITY OF SAINT PAUL i MIJR�TL'SOT�1� OF A CERTAIN PARCEL O�' LAND IN SUMMIT-UNIVERSITY DISTRICT 8; and 4.) NOTICE OF PUBLIC HEARING ON A PROPOSAL FOR A PROGRAM TO FINANCE A MULTI-FAMILY RENTAL HOUSING DEVELOPMEIVT. If you have any questions concerning these publication� please contact me at 292-1577, extension 231. Sincerely, �i��Q. �.���� Sheryl A. Pemberton Real Estate Supervisor Enclosures � . . . . ����!��� NOTICE OF PUBLIC HEARING ON A---- PROPOSAL FOR PROGRAM-- TO FINANCE A . � - MULTI-FAMILY RENTAL HOUSING DEVELOPMENT ' To whom it may concern: � Notice is hereby given that the City Council of the • City of Saint Paul, Minnesota will meet in the City Council Chambers at the City Hall in the City of Saint Paul, Minnesota . at �0 0'clock p.m. on July 28 � • 1983, to consider the proposal of Forest Place L�.m�ted Partnership of St. Paul.,. a Minnesota limited partnership to be formed by David Ames (the "Develaper") that the City undertake a prograrri to finance the development hereinafter described, pursuant to the City's housing plan under Minnesota Statutes, Chapter 462C, by the issuance of revenue bonds. . The Development , The development consists of the construct�.on and equipping of a multi-family rental housing development of approximately 60 rental units located at the intersection of Nebraska and Marion Streets, Saint Paul, - Minnesota. Z'Ize development will be occupied primarily by persons of low or moderate � income. Not less than 20� (approximately 12 units) of the units in the development will be occupied by persons of low income, a category presently defined under federal Iaw . to mean persons eligible for assistance under Section 8 of the National Housing Act. Total approximate development costs will be $3,000,000. The development will be owned and operated by Forest Place Limited Partnership of St. Paul. Non-housing components will not be included within the development. The estimated principal amount of bonds or other obli- gations to be issued to finance the Development is $3,000,000. � s Y'� __ �j�.�. � . . ._ . , . • . . _ �!������ Said bonds or other obligations, as and when issued, � wi11 not constitute a charge, lien or encumbrance upon any pr�dperty of the City of Saint Paul, or its housing and re�,�evelopment authority except the Development and the revenues ta� be derived from the Developinent. Such bonds or obligations witl not be a charge against the City' s general credit or taxing powers but are payable from sums to be paid by the Developer pursuant to revenue agreements. Further information concerning the deveiopments, and tT:� financing programs therefor, may be obtained from the H�iising Division, Department of Planning and Economic Development, City Hall Annex - 12th floor, 25 West 4th Street, S't• Paul, .Minnesota 55102 = _-- - .-- _ -- _.� At the tim� and place fixed for the public hearing, th� City Councii of the City of Saint Paul, Minnesota will given all persons who appear at the hearing an opportunity to ex?ress their views with respect to the proposal. Dated this �th day of July , 1983. . � (BY ORDER OF THE� CITY COUNCIL O�' THE.CITY OF SAZNT PAUL, MINLJESOTA) • � By � Albert B. olson - � . City. Clerk . ������� PED DEPARTI•1ENT KEN GAUTHIER _____^rONTACT 292-1577 (2ss) PHONE �t'� �� ' July 19, 1983 DATE �v� ' ,� (Routing and Explanation Sheet) Assign Number for Routing Orc�r (Clip All Locations for Mayoral Signature): 1 Department Di rector�%�F� � �_ City Attorney t/Mayor R�CEIVED Finance and Management ervi ces Director J U L 2 0 1983 4 City Clerk Budget Di rector MAYORS OFFICE , What Will be Achieved by Taking Action on the Attached Materials? (Purpose/Rationale): Preliminary approval will be given to this project under Minnesota, Statutes, Chapter 462C, authorizing HRA to issue Housing Revcnue Bonds and submission of said financing Program to Minnesota Housing Finance Agency. Financial , Budgetary and Personnel Impacts Anticipated: PED/HRA staff assistance in the sale of the site for this proposed housing development to the developer. �- Funding Source and Fund Activity Number Charged or Credited: Housi.ng Revenue Funds and HRA Tax Levy Fund Attachments (List and Number all Attachments) : Council Resolution (for approval) HRA Resolution DEPARTMENT REVIEW � CITY ATTORNEY REVIEW Yes No Council Resolution Required? Resolution Required? x Yes No Yes No Insurance Required? Insurance Sufficient? Yes _ No Yes No Insurance Attached? Revision of October, 1982 (See Reverse Side for �Instructions) ��`_�'�9f"°� � ''� �. 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