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APPENDIX A <br /> FORM OF REFUNDING BOND <br /> R- <br /> UNITED STATES OF AMERICA <br /> STATE OF INDIANA COUNTY OF ST. JOSEPH <br /> CITY OF SOUTH BEND, INDIANA <br /> SEWAGE WORKS REVENUE REFUNDING BOND OF 202[_] <br /> Interest Maturity Original Authentication <br /> Rate Date Date Date CUSIP No. <br /> , 20_ , 202_ , 202_ <br /> REGISTERED OWNER: <br /> PRINCIPAL SUM: Dollars ($ ) <br /> The City of South Bend, in St. Joseph, County, State of Indiana (the "City"), for value <br /> received,hereby promises to pay to the Registered Owner set forth above, solely out of the special <br /> revenue fund hereinafter referred to, the Principal Sum set forth above on the Maturity Date set <br /> forth above (unless this bond be subject to and be called for redemption prior to maturity as <br /> hereafter provided), and to pay interest thereon until the Principal Sum shall be fully paid at the <br /> Interest Rate per annum specified above from the interest payment date to which interest has been <br /> paid next preceding the Authentication Date of this bond unless this bond is authenticated after the <br /> fifteenth day of the month preceding the interest payment date (the "Record Date") and on or <br /> before such interest payment date in which case it shall bear interest from such interest payment <br /> date,or unless this bond is authenticated on or before ,20_, in which case it shall <br /> bear interest from the Original Date, which interest is payable semiannually on June 1 and <br /> December 1 of each year,beginning on 1, 20_. Interest shall be calculated on the <br /> basis of a 360-day year comprised of twelve 30-day months. <br /> [The principal of and premium, if any, on this bond are payable at the principal office of <br /> (the "Registrar" or "Paying Agent"), in , Indiana.] All <br /> payments of interest on this bond shall be paid by check mailed one business day prior to the <br /> interest payment date to the Registered Owner as of the Record Date at the address as it appears <br /> on the registration books kept by the Registrar or at such other address as is provided to the Paying <br /> Agent in writing by the Registered Owner. Each Registered Owner of$1,000,000 or more in <br /> principal amount of bonds shall be entitled to receive interest payments by wire transfer by <br /> A-1 <br />