Completion and timely submittal of this form to the West Virginia State Treasurer's Office will assure your compliance with West Virginia State law and will assist in the maintenance of a complete data base. West Virginia Code  §12-6A-6(b) requires the issuer of State debt to report the terms of the sale to the Treasurer.
Additionally, please send a copy of the complete transcript of the bond issue to the Treasurer's Office.

Official statement: Attached To be sent None available
Complete Transcript: Attached To be sent None available
 
GENERAL INFORMATION
Name of Issuer:
Issue Name:
Dated:
Principal amount sold:
Interest cost: % (please provide True Interest Cost)
  Variable (please specify)
Underwriter(s) or Purchaser(s):
Is the Interest on the Debt Exempt from Taxation?
  Under State Law:    
No (taxable) Yes (tax-exempt)
  Under Federal Law:
No (taxable) Yes (tax-exempt)
If the issue is Federally tax-exempt, is interest a specific preference item for the purpose of alternative minimum tax? Yes No
Is any portion of the debt for refunding?
No
Yes, amount of this issue (including costs)
        which is for refunding of existing debt $
 
ISSUANCE COSTS
Please indicate the parties involved and the applicable fees.
An attachment may be provided in lieu of this form.
Special Bond Election $
Bond Counsel $
Issuer Counsel $
Underwriter Counsel $
Disclosure Counsel $
Local Counsel $
Tax Counsel $
Accounting/Auditing $
Financial Advisor $
Bond Insurance $
Rating Agency #1 $
Rating Agency #2 $
Rating Agency #3 $
Preparation of Public Notice $
O/S Publication Costs $
Bond Printing Costs $
Trustee Fees $
Signature Company Costs $
Other (please attach complete list)
 
CREDIT RATING
INDICATE CREDIT RATING: (For example, "AAA" or "Aaa")
Rated
Standard & Poor's:
Fitch:
Moody's:
Other:
NOT Rated
 
CREDIT ENHANCEMENT
Was the Issue insured or guaranteed?
No    Bond    Letter(s) of credit     Other
Guarantor's Name:
 
DISCOUNT/PREMIUM
The Bond was sold at: (select all that apply)
   A Discount     A Premium
If Bond was sold at a Premium, please indicate amount: $
If Bond was sold at a Discount, please indicate:
  Original Issue Discount $
  Underwriter's Discount $
 
MATURITY SCHEDULE

Please attach a maturity schedule for the bond issue if a complete transcript or official statement is not available.

Provide the following information:
1) Maturity Date
2) Principal Amount
3) Interest Rate
 
OTHER INFORMATION
Source of Funds utilized for repayment of the issue:
Name of individual (representing Bond Counsel, Issuer, Financial Advisor, or Lead Underwriter) who completed this form and may be contacted for information:
Name:
Firm/Agency:
Address:
e-Mail Address:
Phone:
Contact person at issuing agency, if different from above:
Name:
Title:
Address:
e-Mail Address:
Phone:
 
 
   
  Once this online form is processed it will be time   
stamped and emailed to the listed contact person.