ATTACHMENT III
| Agency Name:__________________ | Contact Person:____________________ | Phone:____________ |
| Agency/Program No. | Program Description | Comments |
|---|---|---|
| __ __ __ __ __ __ | ________________________________ | _________________ |
| __ __ __ __ __ __ | ________________________________ | _________________ |
| __ __ __ __ __ __ | ________________________________ | _________________ |
| __ __ __ __ __ __ | ________________________________ | _________________ |
| __ __ __ __ __ __ | ________________________________ | _________________ |
| __ __ __ __ __ __ | ________________________________ | _________________ |
| __ __ __ __ __ __ | ________________________________ | _________________ |
| __ __ __ __ __ __ | ________________________________ | _________________ |
| __ __ __ __ __ __ | ________________________________ | _________________ |
| __ __ __ __ __ __ | ________________________________ | _________________ |
| __ __ __ __ __ __ | ________________________________ | _________________ |
| __ __ __ __ __ __ | ________________________________ | _________________ |
| __ __ __ __ __ __ | ________________________________ | _________________ |
| __ __ __ __ __ __ | ________________________________ | _________________ |
| __ __ __ __ __ __ | ________________________________ | _________________ |
| __ __ __ __ __ __ | ________________________________ | _________________ |
| __ __ __ __ __ __ | ________________________________ | _________________ |
| ___________________ | ___________________________ | |
| Date | Approved by Agency Head |
Instructions: This form should be used to establish program accounts for the Tax-Exempt Bond Proceeds Fund. Please submit the original to OPM with copies to the State Treasurer and the State Comptroller. NOTE: An Agency should use only one agency number.
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