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. <br />~- FORM C: CONFiDENTIAL STATEMENT OF FINANCIAL CAPABILITY <br />(For confidential official use of the Goose Hollow Local Development Committee and the <br />Tri-County Metropolitan Transit Authority, and their agents) <br />a. Name of Developer: <br />b. Address of Developer: <br />2. The land which the Developer proposes to redevelop is described as <br />follows: <br />Project at Lu Yen <br />3. a. The financial condition of the Developer, as of , <br />199 , is as reflected in the attached financial statement. <br />NOTE: Attach to this statement a certified financial statement showing the <br />v"~ assets and the liabilities, including contingent liabilities, fully itemized in <br />accordance with accepted accounting standards and based on a proper audit. If <br />the date of the certified financial statement precedes the date of this submission <br />by more than six (6) months, also attach an interim balance sheet not more than <br />sixty (60) days old. If the Developer-or the entity responsible for development is <br />to be newly formed for this project, include audited financial statements for the <br />owner(s) of the new entity (corporate and/or individual). <br />b. Name and address of auditor or public accountant who performed <br />the audit on which said financial statement is based. <br />4. If funds for the development of the land are to be obtained from sources other <br />than the Developer's own funds, provide a statement of the Developer's plan for <br />financing the acquisition and development of the land by completing the Items 5 <br />and 6 below, indicating a proposed source(s) and amount of equity investment <br />and proposed source(s) and amounts of debt financing. <br />NOTE: Attach letters of interest from these sources of financing indicating <br />preliminary interest in providing the requested financing to the Developer and the <br />Project. <br />~ <br />Form C.• Confrdential Statement of Financial Capability Page 17 <br />