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Form 8038 Information Return For Tax-Exempt Private Activity Bond Issues Form. This is a Official Federal Forms form and can be use in Department Of Treasury.
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Form 8038(Rev. September 2018) Department of the Treasury Internal Revenue Service Information Return for Tax-Exempt Private Activity Bond Issues(Under Internal Revenue Code section 149(e)) See separate instructions. Go to www.irs.gov/Form8038 for instructions and the latest information. OMB No. 1545-0720 Part I Reporting Authority Check if Amended Return 1 Issuer222s name 2 Issuer222s employer identification number 3a Name of person (other than issuer) with whom the IRS may communicate about this return (see instructions) 3b Telephone number of other person shown on 3a 4 Number and street (or P.O. box if mail is not delivered to street address) Room/suite 5 Report number (For IRS Use Only) 1 6 City, town, or post office, state, and ZIP code 7 Date of issue (MM/DD/YYYY) 8 Name of issue 9 CUSIP number10a Name and title of officer or other employee of the issuer whom the IRS may call for more information 10b Telephone number of officer or other employee shown on 10a Part II Type of Issue (Enter the issue price.) Issue Price11 Exempt facility bond:a Airport (sections 142(a)(1) and 142(c))..................... 11a b Docks and wharves (sections 142(a)(2) and 142(c)) ................ 11b c Water furnishing facilities (sections 142(a)(4) and 142(e)) .............. 11c d Sewage facilities (section 142(a)(5)) ..................... 11d e Solid waste disposal facilities (section 142(a)(6)) ................. 11e f Qualified residential rental projects (sections 142(a)(7) and 142(d)) (see instructions) ..... 11fMeeting 2022650 test (section 142(d)(1)(A)) ............ Meeting 4022660 test (section 142(d)(1)(B)) ............ Meeting 2522660 test (NYC only) (section 142(d)(6)) .......... Has an election been made for deep rent skewing (section 142(d)(4)(B))? .. Yes No g Facilities for the local furnishing of electric energy or gas (sections 142(a)(8) and 142(f)).... 11g h Facilities allowed under a transitional rule of the Tax Reform Act of 1986 (see instructions) ... 11h Facility type 1986 Act section i Qualified enterprise zone facility bonds (section 1394) (see instructions) ......... 11i j Qualified empowerment zone facility bonds (section 1394(f)) (see instructions) ....... 11j k Other (see instructions) 11k l Qualified public educational facility bonds (sections 142(a)(13) and 142(k)) ........ 11l m Mass commuting facilities (sections 142(a)(3) and 142(c)) .............. 11m n Qualified highway or surface freight transfer facilities (sections 142(a)(15) and 142(m)) ..... 11no Other (see instructions) p Local district heating or cooling facilities (sections 142(a)(9) and 142(g)) 11p q Other (see instructions) 11q 12aQualified mortgage bond (section 143(a)) ................... 12a b Other (see instructions) 12b 13 Qualified veterans222 mortgage bond (section 143(b)) (see instructions) ......... 13 Check the box if you elect to rebate arbitrage profits to the United States ..... 14 Qualified small issue bond (section 144(a)) (see instructions) ............ 14 Check the box for $10 million small issue exemption ............ 15 Qualified student loan bond (section 144(b)) .................. 15 16 Qualified redevelopment bond (section 144(c)) ................. 16 17 Qualified hospital bond (section 145(c)) (attach schedule227see instructions) ........ 17 18 Qualified 501(c)(3) nonhospital bond (section 145(b)) (attach schedule227see instructions) .... 18 Check box if 95% or more of net proceeds will be used only for capital expenditures . 19 Nongovernmental output property bond (treated as private activity bond) (section 141(d)) ... 19 20a Other (see instructions) b Reissuance (see instructions) 20b c Other. Describe (see instructions) 20c For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 49973K Form 8038 (Rev. 9-2018) American LegalNet, Inc. www.FormsWorkFlow.com Form 8038 (Rev. 9-2018) Page 2 Part III Description of Bonds (Complete for the entire issue for which this form is being filed.)21 (a) Final maturity date (b) Issue price (c) Stated redemption price at maturity (d) Weighted average maturity (e) Yield $ $ years % Part IV Uses of Proceeds of Issue (including underwriters222 discount) Amount22 Proceeds used for accrued interest ..................... 22 23 Issue price of entire issue (enter amount from line 21, column (b))........... 23 24 Proceeds used for bond issuance costs (including underwriters222 discount) 24 25 Proceeds used for credit enhancement ............ 25 26 Proceeds allocated to reasonably required reserve or replacement fund . 26 27 Proceeds used to refund prior tax-exempt bonds. Complete Part VI .. 27 28 Proceeds used to refund prior taxable bonds. Complete Parts V and VI . 28 29 Add lines 24 through 28 ......................... 29 30 Nonrefunding proceeds (subtract line 29 from line 23, enter amount here, and complete Part V) . 30 Part V Description of Property Financed Caution: Do not complete for qualified student loan bonds, qualified mortgage bonds, or qualified veterans222 mortgage bonds.31 Type of Property Financed: Amounta Land ............................... 31a b Buildings and structures ......................... 31b c Equipment with recovery period of more than 5 years ............... 31c d Equipment with recovery period of 5 years or less ................ 31d e Other. Describe (see instructions) 31e 32 North American Industry Classification System (NAICS) of the projects financed. NAICS Code Amount of nonrefunding proceeds a $b $ NAICS Code Amount of nonrefunding proceeds c $ d $ Part VI Description of Refunded Bonds (Complete this part only for refunding bonds.)33 Enter the remaining weighted average maturity of the tax-exempt bonds to be refunded..... years34 Enter the remaining weighted average maturity of the taxable bonds to be refunded ...... years35 Enter the last date on which the refunded tax-exempt bonds will be called (MM/DD/YYYY).... / /36 Enter the date(s) the refunded bonds were issued (MM/DD/YYYY) ............ / / Part VII Miscellaneous37 Name of governmental unit(s) approving issue (see the instructions) 38 Check the box if you have designated any issue under section 265(b)(3)(B)(i)(III) .............. 39 Check the box if you have elected to pay a penalty in lieu of arbitrage rebate .............. 40 a Check the box if you have identified a hedge and enter the following information............. b Name of hedge providerc Type of hedge d Term of hedge 41 Check the box if the hedge is superintegrated ......................... 42 a Enter the amount of gross proceeds invested or to be invested in a guaranteed investment contract (GIC) b Enter the final maturity date of the GIC (MM/DD/YYYY) ................. / /c Enter the name of the GIC provider 43 Check the box if the issuer has established written procedures to ensure that all nonqualified bonds of this issue are remediated in accordance with the requirements under the Code and Regulations (see instructions)....... 44Check the box if the issuer has established written procedures to monitor the requirements of section 148 .... 45a Enter the amount of reimbursement if some portion of the proceeds was used to reimburse expenditures . b Enter the date the official intent was adopted (MM/DD/YYYY) .............. / /46Check the box if the issue is comprised of qualified redevelopment, qualified small issue, or exempt facilities bonds, and provide name and EIN of the primary private user ....................... Name EIN Form 8038 (Rev. 9-2018) American LegalNet, Inc. www.FormsWorkFlow.com Form 8038 (Rev. 9-2018) Page 3 Part VIII Volume Caps Amount47Amount of state volume cap allocated to the issuer. Attach copy of state certification .... 47 48Amount of issue subject to the unified state volume cap.............. 48 49Amount of issue not subject to the unified state volume cap or other volume limitations: 49 a Of bonds for governmentally owned solid waste facilities, airports, docks, wharves, environmental enhancements of hydroelectric generating facilities, or high-speed intercity rail facilities.... 49a bUnder a carryforward election. Attach a copy of Form 8328 to this return ......... 49b c Under transitional rules of the Tax Reform Act