An authority may require any request for private activity bond financing when submitted to the authority to be accompanied by a statement in the following form, but the absence of any such form shall not affect the validity of a private activity bond:

________________

Date

_________________

(Name of Applicant)

_________________

(Facility)

Signature

____________________

Authority Chairman

_____________________

Name of Authority

If one or more of the above questions do not apply to the facility indicate by writing N/A (not applicable) on the appropriate line.

The provisions of this section shall not apply to bonds, notes or other obligations issued pursuant to hearings held and governmental approvals obtained prior to the effective date of this act in compliance with federal law or regulation.