(Muncipal) City, County And Public Entity Rescue Program Municipal and Public Entity Financial Rescue Intake Form – 711rescue

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(Muncipal) City, County And Public Entity Rescue Program Municipal and Public Entity Financial Rescue Intake Form

Entity Name:

Entity Type:CityTownCountyTax DistrictMunicipal UtilitySchool DistrictPublic Improvement DistrictOther Public Service Entity (please specify):

Primary Contact Name:

Contact Title:

Contact Phone #:

Contact Email Address:

Entity Address:

State

Population Served:

Total Current Bond/Debenture Debt:

USD

Types of Bonds/Debentures

Check all that apply and provide amountsGeneral Obligation BondsRevenue BondsSpecial Assessment BondsDebenturesOther (please specify)

General Obligation Bonds Ammount

USD

Revenue Bonds Amount

USD

Special Assessment Bonds Amount

USD

Other (please specify) Amount

USD

Debentures Amount

USD

Current Annual Budget

Total Revenue

USD

Total Expenses

USD

Current Deficit/Surplus

USD

Projected Next Fiscal Year

Projected Revenue

USD

Projected Expenses

USD

Projected Deficit/Surplus

USD

Please describe the nature of your entity's financial distress:

How long has your entity been experiencing financial difficulties?

Have you missed any bond/debenture payments?yesno

Have you missed any bond/debenture payments? Details

Are there any immediate threats to essential public services due to financial constraints?yesno

Are there any immediate threats to essential public services due to financial constraints?Details

Have you received state government authorization to seek debt restructuring?yesno

Have you received state government authorization to seek debt restructuring?Details

Have you engaged in good faith negotiations with creditors?yesno

Have you engaged in good faith negotiations with creditors?Details

What is the estimated amount of immediate capital injection needed?

What is your preferred timeframe for implementing a rescue plan?Immediate (0-30 days)31-90 days

Which areas of your operations require the most urgent financial support?Public Safety (Police/Fire)Infrastructure MaintenanceEducationPublic HealthUtilitiesOther (please specify):

23. Have you attempted any previous debt restructuring or rescue plans?yesno

23. Have you attempted any previous debt restructuring or rescue plans?Details

Please provide any additional information that you believe is relevant to your entity's financial situation:

Third Party Authorization Form

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Fill the form and upload here Click here to Download

711 Rescue Advisory Agreement

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Fill the form and upload here Click here to Download

Payment confirmation

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(via Zelle or PayPal to Saveme@711Rescue.com)

Most recent audited financial statements (last 3 years)

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Current year-to-date financial statements

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Detailed schedule of all outstanding bonds and debentures

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Most recent budget document

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Long-term financial projections (if available)

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Any relevant reports or studies on the entity's financial condition

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Documentation of state government authorization for debt restructuring

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Minutes or summaries of meetings with creditors

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List of essential services and their current operational status

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Any legal opinions regarding the entity's debt obligations

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Recent bond/debenture offering documents

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Any existing plans for financial recovery or service restructuring

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Initial here

____ (Initial here) By submitting this form, you certify that all information provided is true and
accurate to the best of your knowledge. 711 Rescue.com will review your submission and
contact you to discuss the next steps in the CITY, COUNTY AND PUBLIC ENTITY RESCUE
PROGRAM.

Thank you for choosing 711 Rescue.com for your public entity financial rescue needs.

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