Form 8038-T Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate (Rev. April 2011) Part I OMB No. 1545-1219 Under Sections 143(g)(3) and 148(f) and Section 103(c)(6)(D) of the Internal Revenue Code of 1954 ▶ Department of the Treasury Internal Revenue Service Reporting Authority Check box if Amended Return ▶ 1 Issuer’s name 2 Issuer’s employer identification number (EIN) 3 Number and street (or P.O. box no. if mail is not delivered to street address) 4 Report number (For IRS Use Only) 5 City, town, or post office, state, and ZIP code 6 Date of issue 7 Name of issue 8 CUSIP number 9 Name and title of officer of the issuer or other person whom the IRS may call for more information 10 11 Type of issue ▶ Issue price ▶ 12 13 14 15 Computation date to which this payment relates (MM/DD/YYYY) . . . . . Arbitrage rebate payment (see instructions) check box if less than 100% of rebate amount . . . Yield reduction payment (see instructions) check box if less than 100% of yield reduction amount Rebate payment from Qualified Zone Academy Bond (QZAB) defeasance escrow (see instructions) . . Room/suite 7 Part II Part III Telephone number of officer or other person 11 Arbitrage Rebate and Yield Reduction Payments 13 14 15 Penalty in Lieu of Arbitrage Rebate 16 Number of months since date of issue: 17 18 19 6 mos 12 mos 18 mos Penalty in lieu of rebate . . . . . . . Date of termination election (MM/DD/YYYY) . Penalty upon termination . . . . . . Amount Part IV . . . 24 mos . . . . . . . . . . . . . . . . . . Other. No. of mos ▶ . . . . . . . . . . . . . . . . . . . 17 . . . 19 Late Payments 20 Does failure to pay timely qualify for waiver of penalty (see instructions) . . 21 22 Penalty for failure to pay on time (see instructions) Interest on underpayment (see instructions) . . . . . . . . . . . . . . . . . . . . . . 21 22 Total payment. Add lines 13, 14, 15, 17, 19, 21, and 22. Enter total here . . . . . . . . . 23 . . . . . . . . . Part V 23 Part VI . . . . . . . . . . . . Yes No Total Payment Miscellaneous 24 Unspent proceeds as of this computation date 25 26 Proceeds used to redeem bonds . . . . . . . . . . . . . . . . . . . . . Gross proceeds used for qualified administrative costs for guaranteed investment contracts (GICs) and defeasance escrows . . . . . . . . . . . . . . . . . . . . . . . . . 26 27 Fees paid for a qualified guarantee . 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 25 . Yes 28 29 Is the issue a variable rate issue? . Did the issuer enter into a hedge? 30 Were gross proceeds invested in a GIC? 31 32 Were any gross proceeds invested beyond an available temporary period? . . . . Calculations for filing of this form prepared by: Issuer Preparer: . . . . . . Name of provider . . . . . . . . . . . . . . . . 28 . Term of hedge Name of provider Term of GIC 29 30 Signature of issuer’s authorized representative Print/Type preparer’s name Date Preparer's signature ▲ Paid Preparer Use Only . . . . . . . . . . 31 . 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 consent to the IRS's disclosure of the issuer's return information, as necessary to process this return, to the person that I have authorized above. ▲ Signature and Consent . No Type or print name and title Date Check if self-employed Firm’s name ▶ Firm's EIN Firm's address ▶ Phone no. For Paperwork Reduction Act Notice, see the separate instructions. Cat. No. 11545Y PTIN ▶ Form 8038-T (Rev. 4-2011) American LegalNet, Inc. www.FormsWorkFlow.com