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No.R- $
<br /> CITY OF ZEPHYRHILLS,FLORIDA
<br /> INFRASTRUCTURE SALES SURTAX REVENUE BOND,SERIES
<br /> Interest Rate Maturity Date Date of Original Issue CUSIP
<br /> 1,
<br /> 1 Registered Holder:
<br /> Principal Amount:
<br /> KNOW ALL MEN BY THESE PRESENTS, that the City of Zephyrhills, Florida, a
<br /> municipality created and existing under and by virtue of the laws of the State of Florida (the
<br /> "Issuer"), for value received,hereby promises to pay, solely from the Pledged Funds hereinafter
<br /> described, to the Registered Holder identified above, or registered assigns as hereinafter
<br /> provided, on the Maturity Date identified above, the Principal Amount identified above and
<br /> interest on such Principal Amount from the Date of Original Issue identified above or from the
<br /> most recent interest payment date to which interest has been paid at the Interest Rate per
<br /> annum identified above on April 1 and October 1 of each year commencing _ 1,
<br /> until such Principal Amount shall have been paid, except as the provisions hereinafter set
<br /> forth with respect to redemption prior to maturity may be or become applicable hereto. Interest
<br /> on this Bond shall be computed on the basis of a 360-day year consisting of twelve 30-day
<br /> months.
<br /> Such Principal Amount and interest and the redemption premium, if any, on this Bond
<br /> are payable in any coin or currency of the United States of America which, on the respective
<br /> dates of payment thereof, shall be legal tender for the payment of public and private debts.
<br /> Such Principal Amount and the redemption premium, if any, on this Bond, are payable, upon
<br /> presentation and surrender hereof, at the designated corporate trust office of
<br /> , as Paying Agent. Payment of each installment
<br /> of interest shall be made to the person in whose name this Bond shall be registered on the
<br /> registration books of the Issuer maintained by , as
<br /> Registrar, at the close of business on the date which shall be the fifteenth day (whether or not a
<br /> business day) of the calendar month next preceding each interest payment date and shall be
<br /> paid by a check or draft of such Paying Agent mailed to such Registered Holder at the address
<br /> appearing on such registration books or, at the option of such Paying Agent, and at the request
<br /> and expense of such Registered Holder, by bank wire transfer for the account of such Holder.
<br /> In the event interest payable on this Bond is not punctually paid or duly provided for by the
<br /> Issuer on such interest payment date, payment of each installment of such defaulted interest
<br /> shall be made to the person in whose name this Bond shall be registered at the close of business
<br /> on a special record date for the payment of such defaulted interest as established by notice to
<br /> such Registered Holder,not less than ten days preceding such special record date.
<br /> This Bond is one of an authorized issue of Bonds in the aggregate principal amount of
<br /> $ (the "Bonds") of like date, tenor and effect, except as to maturity date, interest rate,
<br /> denomination and number,issued to finance and/or reimburse the cost of temporary relocation,
<br /> designing, permitting, acquisition, construction, reconstruction and/or equipping of
<br /> under the authority of and in full compliance with Constitution and laws
<br /> of the State of Florida, Chapter 166, Florida Statutes, Chapter 212, Florida Statutes, Chapter 218,
<br /> Part IV, Florida Statutes, the Charter of the Issuer, Ordinance No. 12-16 enacted by the Board of
<br /> County Commissioners of Pasco County, Florida on July 10, 2012, and a successful referendum
<br /> conducted thereunder on November 6, 2012 where the one-cent local infrastructure sales surtax
<br /> was extended through December 31, 2024 (collectively, the "Act"), and a resolution duly
<br /> adopted by the City Council of the Issuer on October 23, 2017, as amended and supplemented
<br /> from time to time, and as particularly supplemented by a resolution duly adopted by the City
<br /> Council of the Issuer on , 20_ (collectively, the "Resolution"), and is subject to the
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