Form 8038-CP (Rev. January 2012) Department of the Treasury Internal Revenue Service Return for Credit Payments to Issuers of Qualified Bonds 2 OMB No. 1545-2142 Part I 1 Information on Entity That Is To Receive Payment of Credit and Communications Check box if Amended Return Name of entity that is to receive payment of the credit Employer identification number (EIN) 3 Number and street (or P.O. box no. if mail is not delivered to street address) Room/suite 4 City, town, or post office, state, and ZIP code 6 5 Name and title of designated contact person whom the IRS may call for more information Telephone number of officer or legal representative Part II 7 Reporting Authority 8 EIN Report number (For IRS Use Only) Date of issue (MM/DD/YYYY) Issuer's name (if same as line 1, enter "SAME" and skip lines 8, 9, 11, 15, and 16) 9 Number and street (or P.O. box no. if mail is not delivered to street address) Room/suite 10 11 City, town, or post office, state, and ZIP code 12 13 Name of issue 14 CUSIP number (see instructions) 15 Name and title of officer or other person whom the IRS may call for more information 16 Telephone number of officer or other person to call 17a b c 18 19a b c 20 a b c d e f 21 a b 22 23 24 Type of issue For build America bonds and recovery zone economic development bonds, check the applicable box (see instructions) Utilities Other Educational Health and Hospital Transportation Public Safety Environmental Housing For build America bonds, recovery zone economic development bonds, and specified tax credit bonds, enter the issue price . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17b Check applicable box Variable rate bond Fixed rate bond Part III Payment of Credit (For specified tax credit bonds with multiple maturities, see instructions.) . . . . . . . . . . 19a Interest payment date to which this payment of credit relates (MM/DD/YYYY) Interest payable to bondholders on the interest payment date . . . . . For specified tax credit bonds only, enter the applicable credit rate determined under Sec. 54A(b)(3) . % For specified tax credit bonds only, enter the interest that would be payable to bondholders on the interest payment date calculated using the applicable credit rate (see instructions) . . . . . . . . . . . Amount of credit payment to be received as of the interest payment date (complete only line 20a, 20b, 20c, 20d, 20e, or 20f) Build America bonds. Multiply line 19a by 35% . . . . . . . . . . . Recovery zone economic development bonds. Multiply line 19a by 45% . . . . New clean renewable energy bonds enter the lesser of line 19a or 70% of line 19c . Qualified energy conservation bonds enter the lesser of line 19a or 70% of line 19c Qualified zone academy bonds enter the lesser of lines 19a or 19c . . . . . Qualified school construction bonds enter the lesser of lines 19a or 19c . . . . Adjustment to previous credit payments (complete line 21a OR line 21b only): Net increase to previous payments (attach explanation) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19c 20a 20b 20c 20d 20e 20f 21a 21b 22 ... ... Net decrease to previous payments (attach explanation) . . . . . . . . . . . . . . . . Amount of credit payment to be received. Combine either line 20a, 20b, 20c, 20d, 20e, or 20f with line 21a or line 21b . Is this the final interest payment date? . . . . . . . . . . . . . . . . . . . . . . If the entity identified in Part I is not the issuer, check this box . . . . . . . . . . . . . . . 25 a c Enter direct deposit information below: Routing number Account number b Type: Checking Savings Yes .. No . . Direct Deposit Signature and Consent Under penalties of perjury, I declare that I have examined this return, and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and complete. I further declare that I authorize the IRS to send the requested refundable credit payment to the entity identified in Part I, and I consent to the disclosure of the issuer's return information, as necessary to process the refundable credit payment, to the designated contact person(s) listed above in Parts I and II, as applicable. Signature of issuer Date Preparer's signature Paid Preparer Use Only Print/Type preparer's name Type or print name and title Date PTIN Check if self-employed Firm's EIN Phone no. Cat. No. 52810E Form 8038-CP (Rev. 1-2012) American LegalNet, Inc. www.FormsWorkFlow.com Firm's name Firm's address For Paperwork Reduction Act Notice, see the separate instructions.