1. MIDA Bond Hospice of Red River Valley

CASS COUNTY MIDA BOND APPLICATION FORM I. Name of applicant: Hospice of the Red River Valley 2. Telephone number of applicant: 356-1500 3. Size of issue requested: $2.600,000 4. Type of issue ( check one): (a) Small issue - $1,000.000 [Section 144(a)] (b) Small issue - $10.000,000 [Section 144(a)(4)] (c) Qualified residential rental project [Section 142(a)(7)] (d) X Qualified 501(c)(3) issue [Section 145] (e) Refunding issue (0 Other (specify type): 5. Iftype of issue checked was small issue ($1 ,000,000 or $1 0,000,000). is issue for a manufacturing facility as defined in Section 144(a)(I2)(C)? Yes No 6. Iftype of issue check was qualified residential rental project. will project meet the low income requirements for tenants as set out in Section 142( d)? Yes No 7. Estimated date of issue if approved by County: July, 2007 8. Give a brief explanation of project, which explanation should include the location of the project description ofthe use of the bond proceeds, and whether or not the project would create additional employment: The Bond proceeds will be used to finance the acquisition ofa two-story, 28,000 square foot office building located at 170 I 38th Street SW, Fargo, North Dakota (the "Project"), The Project will be used by Hospice ofthe Red River Valley for its administrative offices. The Project is not expected to create additional employment. 9. Attached to the Application Form is a check in the amount of$I.OOO which is the application fee, which fee is nonrefundable. If issue does close, the application fee shall be deducted from the issuance fee set out in paragraph II, 10. Attached is a typed Initial Resolution giving project preliminary approval and a Notice of Hearing, both in the form provided by the County Auditor's oflice. The Initial Resolution and Notice shall have a hearing date which has been provided to the applicant by the County Auditor's office. II. The applicant understands that the issuance fee for a new MIDA bond issue is equal to 1% ofthe first $1,000,000 of the Bond issue and that there is no fee beyond the first $1,000,000. For refunding bond issues the issuance fee is one-half of the amount set forth above. Dated: December 14,2006. HOSPICE Of' THE RED RIVER VALLEY By: I ( ; ". 'J/') .~. ,- 'I _3>,-'. t"'--'.. 'Its: Executi~e Dire~tor ' '-)