Form 8038-TC Information Return for Tax Credit Bonds

Version A, Cycle 1

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Form

8038-TC

Information Return for Tax Credit 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.

ital(For IRS Use Only

Check if Amended Return ©

1

Issuer’s name

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In care of: (if applicable)

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

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

7 Date of issue

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Name of issue

9 CUSIP number

10

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4 Report number
(enter unique two-digit number)

Type of Issue

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Tax Credit Bond Code (see instructions, enter three-digit code for the type of issue) .
Description ©

Part III

Description of Obligations

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Issue Price (enter amount) . . . . . . . .
Stated redemption price at maturity (enter amount)
Final maturity date (enter date) . . . . . . .
Applicable credit rate . . . . . . . . . .
Maximum term . . . . . . . . . . . .
Permitted Sinking Fund Yield . . . . . . .

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Issue Price of entire issue (enter amount from Part III, line 1) . . . . . . .
Proceeds used for bond issuance cost (including underwriters' discount) . . .
Estimated investment proceeds . . . . . . . . . . . . . . . .
Expected available project proceeds (Subtract line 2 from line 1 and add line 3) .
Matching pledged funds . . . . . . . . . . . . . . . . . . .
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Other (describe) ©
Total proceeds . . . . . . . . . . . . . . . . . . . . . .

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Part V

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Proceeds of Issue (Including underwriters' discount)

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Description of Use of Proceeds for Qualified Purpose Expenditures

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Loans to qualified borrower(s) (enter amount) . . . . . . . . . . . . . . . . .
If a written loan commitment was obtained prior to issue date, check box ©
Name of borrower ©
EIN of borrower ©
(Attach list if more than one)
Land (if applicable, see instructions) . . . . . . . . . . . . . . . . . . . .
Buildings and structures . . . . . . . . . . . . . . . . . . . . . . . .
Equipment with recovery period of more than 5 years . . . . . . . . . . . . . .
Equipment with recovery period of 5 years or less . . . . . . . . . . . . . . .
Grants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Demonstration projects . . . . . . . . . . . . . . . . . . . . . . . .
Public education campaigns . . . . . . . . . . . . . . . . . . . . . .
Repairs or other rehabilitation expenditures
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Developing course material and/or staff training expenditures
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Pay principal, interest, or premiums on qualified bonds . . . . . . . . . . . . . .
Refinance a qualified indebtedness . . . . . . . . . . . . . . . . . . . .
Other (describe) ©
Total qualified purpose expenditures (Sum of lines 1 through 13)
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Percentage of available project proceeds to be used for qualified purpose expenditures (Divide
14 in Part V by line 7 in Part IV, multiplied by 100) . .multiply
. . result
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If some portion of proceeds were used to reimburse issuer for amounts paid for a qualified purpose,
enter the amount of reimbursement . . . . . . . . . . . . . . . . . . . . .
If some portion of proceeds were used to reimburse issuer for amounts paid for a qualified purpose,
enter the date the official intent was adopted . . . . . . . . . . . . . . . . . .

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(MM/DD/YYYY)

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Part IV

1

11 Telephone number of officer or legal representative

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

Part II
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2 Issuer’s employer identification number (EIN)

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

Cat. No. 53394V

(MM/DD/YYYY)

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Amount

Amount

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Form 8038-TC (1-2010)

Version A, Cycle 1
Page 2

Form 8038-TC (1-2010)

Part VI
1a
b
c
d
2

Allocation of National or State Bond Limitation Amount (Enter source and amount of
allocation and attach copy of certificate)

Allocation amount (enter amount) . . . . .
National, check box ©
State, check box ©
Tribal, check box ©
If box 1c is checked enter State abbreviation ©

Part VII
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4

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Amount
1a

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Miscellaneous

Arbitrage questions:
a If there is a reserve or sinking fund that is expected to repay the issue at maturity, check box . . . . . . . . . ©
b If yes, and the reserve fund is funded in equal periodic installments, check box . . . . . . . . . . . . . . ©
c If the funding of the reserve fund is expected to result in an amount greater than the amount necessary to repay the issue
using the permitted sinking fund yield (line 6, Part III) as the future value interest rate, check box . . . . . . . . ©
d If the issuer has established procedures to monitor the requirements of section 148 with respect to these bonds, check box ©
If all federal, state, and local requirements governing conflicts of interest are satisfied with respect to this issue, check box . ©
If the entitlements to credits with respect to this bond issue are expected to be stripped, check box . . . . . . . ©
If the issuer has established procedures to insure that all nonqualified bonds at the end of the applicable period are
redeemed within 90 days, check box . . . . . . . . . . . . . . . . . . . . . . . . . . . . ©

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Other:

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Here

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©

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©

Paid
Preparer’s
Use Only
Part VIII
1

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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.

Signature of issuer's authorized representative
Preparer’s
signature

Date

Type or print name and title

Date

©

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

©

Preparer’s PTIN

Check if
selfemployed

©

SSN or
EIN

Consent to Disclosure of Certain Information from this Return

Phone no.

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, stated redemption
price at maturity, applicable credit rate, and maximum term, to assist in the proper reporting of interest, tax
credits, or other benefits under IRC 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 IRC section 6049.

Sign
Here

©

Signature

Date

©

Title
Form 8038-B (1-2010)

TC

(EIN)

January 2010

8038-TC
(Generic)
Form

(Rev. Month 2009)

Information Return for Tax Credit Bonds
Schedule of Qualified Zone Academy Bonds
¾ Under Internal Revenue Code section 149(e)
¾ See separate Instructions

Part I

NNN
OMB No. xxxxxxx

Department of the Treasury
Internal Revenue Service

1 Issuer’s Name

Tax Credit Bond Code

2 Issuer’s employer identification number

Questions

Yes

1
2
3
4
5
6
7
8
9
10

1
2
3
4
5
6
7
8
9
10

Part II
Amount
1
2
3
4
5
6
7
8
9
10

Part III
1
2
3

1
2
3
4
5
6
7
8
9
10

Other Information

No

(EIN)
January 2010

8038-TC
Schedule A
Form

(Rev. Month 2009)
Department of the Treasury
Internal Revenue Service

Information Return for Tax Credit Bonds
Schedule of Qualified Zone Academy Bonds
¾ Under Internal Revenue Code section 149(e)
¾ See separate Instructions
i

1 Issuer’s Name

Part I

2 Issuer’s employer identification number

Questions

Yes

Description of Qualified Zone Academy Bonds Private Business
Contribution (enter the value of the amount of contribution in each type)

1 Equipment
2 Technical assistance
3 Services of employees as volunteers
4 Opportunities for students outside of the academy
5 Other ____________________________________________________________

Part III

102
OMB No. xxxxxxx

1 Is the school located in an empowerment zone?
2 Is the school located in an enterprise community zone?
3 Is it expected that at least 35% of students attending the school will be eligible for free or
reduced-cost lunches under the school lunch program established by the National School
Lunch Act?
4 Is a carryover of unused limitation being used for this issue?
5 Has the comprehensive educational plan of the school or program approved by the eligible
local education agency?
6 Was the bond issuance approved by the eligible local education agency?

Part II

Tax Credit Bond Code

No

1
2
3
4
5
6
Amount

1
2
3
4
5

Other Information

1 Enter the name of the donor: _____________________________________________________________________
2 Enter the donor’s EIN: ___________________ (attach schedule if more than one donor)
3 Enter the name of the eligible local education agency: _________________________________________________

January 2010

8038-TC
Schedule B
Form

(Rev. Month 2009)
Department of the Treasury
Internal Revenue Service

1 Issuer’s Name

Part I

(EIN)

Information Return for Tax Credit Bonds
Schedule of Qualified School Construction
Bonds

Tax Credit Bond Code

103

OMB No. xxxxxxx
¾ Under Internal Revenue Code section 149(e)
¾ See separate Instructions
2 Issuer’s employer identification number
i

Questions

Yes

1 Are the proceeds to be used by a large local educational agency? (see instructions)
2 Are the proceeds to be used by an Indian school? (see instructions)
3 Is a carryover of unused limitation being used for this issue?

1
2
3

4 Are all proceeds to be used within the jurisdiction of the issuer?
5 Is the local educational agency one identified by the Secretary of Education to be in
particular need of assistance?

4

Part II

5

Description of Qualified School Construction Bonds (enter the amount of
Amount

proceeds expected to be used)

1 Equipment
2 Technical assistance
3 Services of employees as volunteers
4 Opportunities for students outside of the academy
5 Other ____________________________________________________________

Part III

No

1
2
3
4
5

Other Information

1 Enter the name of the eligible local education agency: _________________________________________________