Form 8038-B Information Return for Build America Bonds and Recovery

Version A, Cycle 4

Form

8038-B

Information Return for Build America Bonds and Recovery Zone
Economic Development Bonds

(Rev. January 2010)
Department of the Treasury
Internal Revenue Service

Part I

©

Reporting Authority

OMB No. XXXX-XXXX

Under Internal Revenue Code section 149(e)
© See separate instructions.

Check if Amended Return ©

1

Issuer’s name

2 Issuer’s employer identification number (EIN)

3

In care of (if applicable)

4 Report number For IRS Use Only
(enter unique two-digit number)

5

Number and street (or P.O. Box if mail is not delivered to street address)

6

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

7 Date of issue

8

Name of issue

9 CUSIP number

10

11 Telephone number of officer or legal representative

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

(

Part II
1a
b
c
2
3
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b
c
d
e
f

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b
c
d
e
f
g
h
2
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b
c
d

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DRAFT AS OF
October 1, 2009

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Type of Issue

Education . . . . . . . . . . . . . . .
Health and hospital . . . . . . . . . . .
Transportation . . . . . . . . . . . . .
Public safety . . . . . . . . . . . . . .
Environment (including sewage bonds) . . . . .
Housing . . . . . . . . . . . . . . .
description
Utilities . . . . . . . . . . . . . . . .
©
Other
For a Recovery zone economic development bond,
attach schedule)

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identify the type of issue and
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Amount

1a
1b
1c
1d
1e
1f
1g
1h

enter the issue price. (see instructions and

Capital expenditures relating to property located in the zone . . . . . . . . . . . .
Public infrastructure and construction of public facilities . . . . . . . . . . . . .
Job training and educational programs . . . . . . . . . . . . . . . . . . .
Other . . description
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Total issue price (Part III, lines 1a through 1h or lines 2a through 2d) . . . . . . . . .
If obligations are TANs or RANs, check box 4a ©
If obligations are BANs, check box 4b ©
If obligations are in the form of a lease or installment sale, check box ©

Part IV
1
2
3
4
5

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For a Build America bond, identify the type of issue, enter the issue price. (see instructions and
attach schedule)

1

3
4
5

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Type of Credit Bonds (see instructions, if the box on line 1b or 1c is checked, complete lines 2 and 3)

Build America bonds (Tax Credit) (section 54AA(a)) . . . . . . . . . . . . . . .
Build America bonds (Direct Payment) (sections 54AA(g) and 6431) . . . . . . . . . .
Recovery zone economic development bonds (Direct Payment) (sections 1400U-2 and 6431) .
Enter the first interest payment date (MM/DD/YYYY) ©
Interest payment date frequency: (check box)
annual,
semi-annual,
and
quarterly,
monthly, or
other
If line 3e above is checked, please describe the payment frequency:

Part III

3

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2a
2b
2c
2d
3

Description of Obligations (Complete for the entire issue for which this form is being filed.)

Stated redemption price at maturity . . . . .
Final maturity date (MM/DD/YYYY) . . . . .
Weighted average maturity . . . . . . . .
Yield . . . . . . . . . . . . . . .
If the issue is a variable rate issue, check box 5a ©

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1
. . . . . . . . . . . . . . .
. . . . . . . .
. . . . .
years
. . . . . . .
%
Please indicate the frequency rates are reset 5b ©

For Paperwork Reduction Act Notice, see page 2 of the instructions.

Cat. No. 53393K

add space

Form 8038-B (1-2010)

Version A, Cycle 4
Page 2

Form 8038-B (1-2010)

Part V
1
2
3
4
5
6
7
8
9
10

Use of Proceeds of Issue

Sales proceeds . . . . . . . . . . . . . . . . . . . . . . . . . .
Expected investment proceeds
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Proceeds used for accrued interest . . . . . . . . . . . . . . . . . . .
Proceeds used for bond issuance cost (including underwriter's discount) . . . . . . .
Proceeds used for credit enhancement . . . . . . . . . . . . . . . . . .
Proceeds allocated to a reasonably required reserve fund . . . when
. . printed
. . shows
. . .gap??
. .
Proceeds used for capital expenditures . . . . . . . . . . . . . . . . . .
Proceeds used for working capital expenditures . . . . . . . . . . . . . . .
Proceeds used to currently refund prior issues
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Proceeds used to advance refund prior issues
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Part VI
1
2
3
4

Amount

Description of Refunded Bonds (complete this part only for refunding bonds)

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1
2
3
4
5
6
7
8
9
10

Enter the remaining weighted average maturity of the bonds to be
years
currently refunded . . . . . . . . . . . . . . . . .
Enter the remaining weighted average maturity of the bonds to be
years
advance refunded . . . . . . . . . . . . . . . . .
Enter the last date on which the refunded bonds will be called (MM/DD/YYYY)
Enter the date the refunded bonds were issued (if more than one date of issue, attach a schedule)
(MM/DD/YYYY) (see instructions) . . . . . . . . . . . . . . .

Part VII

Miscellaneous

1
1
Enter the amount of the state volume cap allocated to the issue (see instructions) . . . . . .
2 a Enter the amount of gross proceeds invested or to be invested in a guaranteed investment contract
(GIC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2a
b Enter the final maturity date of the GIC (MM/DD/YYYY) ©
c Enter the name of the GIC provider ©
3
Proceeds of this issue that are to be used to make loans to other governmental units . . . . .
3
4 a If this issue is a loan made from the proceeds of another tax-exempt issue, check box ©
and enter the following information:
b Enter the date of the master pool obligation (MM/DD/YYYY) ©
c Enter the EIN of the issuer of the master pool obligation ©
d Enter the name of the issuer of the master pool obligation ©
5 a If the issuer entered into a hedge, check box ©
and enter the following information:
b Name of hedge provider ©
c Type of hedge ©
d Term of hedge ©
If the issuer has superintegrated the hedge, check box ©
6
7
If the issuer elected to pay a penalty in lieu of arbitrage rebate, check box ©
If the issuer has established procedures to ensure that all nonqualified bonds of this issue are remediated in accordance with the
8
requirements under Regulations section 1.141-12, check box ©

DRAFT AS OF
October 1, 2009

9

If the issuer has established procedures to monitor the requirements of section 148, check box ©
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
Part VIII
1

Signature of issuer's authorized representative
Preparer’s
signature

Date

Type or print name and title
Check if
selfemployed

Date

©

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

©

©

Preparer’s SSN or PTIN

EIN

Consent to Disclosure of Certain Information from this Return

Phone no.

For Build America bonds that provide a tax credit to bondholders, does the issuer give the IRS consent to publish, through a
website or in a publication, its name and address, name and description of bond issue, date of issuance, CUSIP number, final
maturity date, and stated redemption price at maturity, to assist in the proper reporting of interest, tax credits, or other benefits
under section 6049 and regulations thereunder . . . . . . . . . . . . . . . . . . . . ©
Yes
No

Under penalties of perjury, I declare that I am an officer of the above named issuer and that I am authorized to give consent on behalf of the above named issuer for the IRS
to publish the aforementioned items of information to assist in the reporting obligations under section 6049.

Sign
Here

©

Signature

Date

©

?
Title
Form 8038-B (1-2010)