Form 8038-CP Return for Credit Payments to Issuers of Qualified Bonds

Form

8038-CP

Return for Credit Payments
to Issuers of Qualified Bonds

(April 2009)
Department of the Treasury
Internal Revenue Service

Part I

OMB No. 1545-2142

Information on Entity That Is To Receive Payment of Credit

1

Name of entity that is to receive payment of the credit

3

Number and street (or P.O. box no. if mail is not delivered to street address)

4

City, town, or post office, state, and ZIP code

5

Name and title of officer or legal representative whom the IRS may call for more information

Check box if Amended Return
2

Room/suite

6

Telephone number of officer or legal representative

(

Part II

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Employer identification number (EIN)

)

Reporting Authority

7

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)

8

Room/suite

10

EIN

Report number (For IRS Use Only)

8
11

City, town, or post office, state, and ZIP code

12 Date of issue

13

Name of issue

14 CUSIP number

15

Name and title of officer or legal representative whom the IRS may call for more information

16 Telephone number of officer or legal representative

17a

Type of issue

(

Part III

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)

Issue price

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18

Interest payment date to which this payment of credit relates (MMDDYYYY)

19

Interest payable to bondholders on the interest payment date

20

Amount of credit payment to be received as of the interest payment date (complete line 20a OR
line 20b only):
a

17b

Payment of Credit

19

20a
20b

Build America bonds. Multiply line 19 by 35% (0.35)

b Recovery zone economic development bonds. Multiply line 19 by 45% (0.45)
Adjustment to previous credit payments (complete line 21a OR line 21b only):

21
a

21a
21b (

Net increase to previous payments (attach explanation)

b Net decrease to previous payments (attach explanation)

)

22

22

Amount of credit payment to be received. Combine line 20a or line 20b with line 21a or line 21b

23

Is this the final interest payment date?

24

If the entity identified in Part I is not the issuer, check this box to indicate that the entity is authorized to receive payment and
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related return information on behalf of the issuer

Yes

No

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.

Sign
Here
Paid
Preparer’s
Use Only

©

©
Signature of issuer’s authorized representative
Preparer’s
signature

©

Firm’s name (or
yours if self-employed),
address, and ZIP code

Date

Type or print name and title
Date

©

For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.

Check if
self-employed

Preparer’s SSN or PTIN

EIN
Phone no.
Cat. No. 52810E

(

)
Form

8038-CP

(4-2009)