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ÿÿ ÿÿ ÿÿ · € € à à à à à ÿÿÿÿ × × × × ã $ × G ø ú ú ú ê ì ì ì ì ì ì ? ¢ á n ì à ú Ê 0 ú ú ú ì à à à ¶ ¶ ¶ ú F Ã Ã ê ¶ ú ê ¶ ¶ ¶ ÿÿÿÿ `RŽ¬îÊ × @ ¶ Ö 0 G ¶ O @ v O ¶ O à ¶ ú ú ¶ ú ú ú ú ú ì ì ¶ ú ú ú G ú ú ú ú ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ O ú ú ú ú ú ú ú ú ú € ‰ : Application No.___________
Date Received___________
Receipt No.______________
Amount_________________
TO THE WASHINGTON UTILITIES AND TRANSPORTATION COMMISSION
OLYMPIA, WASHINGTON
Application for Permission to MORTGAGE Certificate of
Public Convenience and Necessity No. ______________
________________________________________________________, holder of Certificate of Public
(Name of Auto Transportation Company)
Convenience and Necessity No.________; asks the consent of the Washington Utilities and Transportation Commission for authority to mortgage said certificate under the provisions of chapter 81.68 RCW to
________________________________________________________________ at the following address:
(Name of Mortgagee)
Said Mortgage will be dated the ______ day of _________________, 20_____, and will be executed and delivered to __________________________________________ for the purpose of securing the sum of $__________________, to be due and payable as follows:
Said indebtedness has been or will be incurred for the following purpose:
Other property to be secured by said mortgage is as follows:
For the most recent 12 month period ending ________________, 20_____, the internally generated funds of the certificate hold consist of the following:
Depreciation $_________________
Net Income $_________________
Other $_________________
Total $_________________
Less the estimated payments during the next 12 month period for:
Interest on existing debt $_________________
Interest of proposed debt $_________________
Principal payments on existing debt $_________________
Principal payments on proposed debt $_________________
Payment on other long term obligations $_________________
Total: $_________________
Balance of internal funds available for other purposes: $___________________
If internally generated funds are insufficient to meet the actual and proposed interest and principal payments, report the source and amount of other funds to be used for these payments.
Attached to and made a part of the application for the following: (a) copy of profit and loss statement for the above described 12 month period; (b) copy of mortgage and related note, bond or debenture; (c) original Certificate of Public Convenience and Necessity issued by the Commission; and (d) $35.00 application fee.
The undersigned applicant requests that the Commission enter an order granting its petition as provided for in chapter 81.68 RCW.
DATED at __ _______________________________________ this _________ day of____________
_________________, 20____.
(Applicant)
By:_______________________________________
Title:______________________________________
State of Washington )
) ss.
County of _____________)
________________________________________, being first duly sworn, deposes and says that he is___________________ applicant in the proceeding entitled above, that he has read the foregoing application and knows the contents thereof; that the same is true of his own knowledge, except as to matters which are therein stated on information or belief, and as to those matters he believes it to be true.
Subscribed and sworn to before me the ______ day of _____________________________, 20___.
Notary Public in and for the state of Washington residing at
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