Form 8038-TC Information Return for Tax Credit Bonds

Version A, Cycle 4

Form

8038-TC

Information Return for Tax Credit Bonds

(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) 3

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

Type of Issue

1
2

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

1
2
3
4
5
6

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

1
2
3
4
5
6
7

Part III

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

1
2

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

4
5
6

Sale Proceeds . . . . . . . . . . . . . . . . . . . . . .
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 . . . . . . . . . . . . . . . . . . .
Other (describe) ©
Total proceeds . . . . . . . . . . . . . . . . . . . . . .

.
.
.
.
.

.
.
.
.
.

.
.
.
.
.

.
.
.
.
.

.
.
.
.
.

.

.

.

.

.

DRAFT AS OF
December 15, 2009

Proceeds of Issue (Including underwriters' discount)

1
2
3
4
5
6
7

1a
b
c
d
2
3
4
5
6
7
8
9
10
11
12
13
14

Loans to qualified borrower(s) . . . . . . . . . . . . . . . . . . . . . . .
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 instruction) . . . . . . . . . . . . . . . . . . . . .
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
. . . . . . . . . . . . . . . . . .
Developing course material and/or staff training expenditures
. . . . . . . . . . . .
Pay principal, interest, or premiums on qualified bonds . . . . . . . . . . . . . . .
Refinance a qualified indebtedness . . . . . . . . . . . . . . . . . . . . .
Other (describe) ©
Total qualified purpose expenditures (Sum of lines 1a through 13) . . . . . . . . . . .

1a

15

Percentage of total proceeds to be used for qualified purpose expenditures (Divide line 14 in Part V
by line 7 in Part IV multiply result by 100) . . . . . . . . . . . . . . . . . . .
If some portion of proceeds was used to reimburse issuer for amounts paid for a qualified purpose,
enter the amount of reimbursement . . . . . . . . . . . . . . . . . . . . .
If some portion of proceeds was to reimburse issuer for amounts paid for a qualified purposes,
enter the date the official intent was adopted (MM/DD/YYYY)

16
17

Description of Use of Proceeds for Qualified Purpose Expenditures

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

%
years
%

Amount

.
.
.
.
.

Part V

©

Description of Obligations
.

Part IV

.

Cat. No. 53394V

Amount

2
3
4
5
6
7
8
9
10
11
12
13
14
15

%

16
17
Form 8038-TC (1-2010)

If the issuer has established procedures to monitor the requirements of
section 148 with respect to these bonds, check box

Version A, Cycle 4
Page 2

Form 8038-TC (1-2010)

Part VI
1a
b
c
d
2

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

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

Part VII
1

2
3
4

Miscellaneous

.
.
.
.
.

.
.
.
.
.

.
.
.
.
.

.
.
.
.
.

.
.
.
.
.

.
.
.
.
.

.
.
.
.
.

.
.
.
.
.

.
.
.
.
.

.
.
.
.
.

.
.
.
.
.

.
.
.
.
.

.
.
.
.
.

.
.
.
.

.
.
.
.

.
.
.
.

.

Amount

1a

.

©
©
©

©

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 there is a reserve or sinking fund that is expected to repay the issue at maturity, 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . ©

5

Other: .

Sign
Here

©

Paid
Preparer’s
Use Only
Part VIII
1

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

©

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
Check if
selfemployed

Date

©

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

©

employer identification number

©

Preparer’s SSN or PTIN

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 7049 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

issue price

©

Title
Form 8038-TC (1-2010)

DRAFT AS OF
December 15, 2009

Version A, Cycle 4
Page 3

Form 8038-TC (1-2010)
Issuer's name:

Issuer's employer identification number (EIN):

Tax Credit Bond Code

Schedule of New Clean Renewable Energy Bonds (CREBs)

Schedule A

©

Under Internal Revenue Code sections 54A and 54C
©

102

See separate instructions.

Issuer Questions

Part I

Yes

1
2
3
4
5

Is the issuer a public power provider? . . . . . . . .
Is the issuer a cooperative electric company? . . . . . .
Is the issuer a governmental body? . . . . . . . . .
Is the issuer a clean renewable energy bond lender? . . . .
Is the issuer a not-for-profit electric utility which has received a
Electrification Act? . . . . . . . . . . . . . . .

6
7
8

Have proceeds been used to acquire existing facilities? (See instructions.) . . . . . . .
Have proceeds been used to refinance existing facilities? (See instructions.) . . . . . . .
Is the volume cap limitation used for this issue within 3 years of the date allocated? (See
instructions.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9
10

. . . . . . .
. . . . . . .
. . . . . . .
. . . . . . .
loan/loan guarantee
. . . . . . .

. .
. .
. .
. .
under
. .

Has the issuer designated these bonds as new CREBs for purposes of section 54C? .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Part III

. . .
. . .
. . .
. . .
the Rural
. . .

No

1
2
3
4
5
6
7

.
.

.
.

.
.

.
.

8
9
10

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

1
2
3
4
5
6
7
8
9
10

Amount
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

DRAFT AS OF
December 15, 2009

List of Qualified Renewable Energy Facilities

List the type of Qualified Renewable energy Facility (see instructions) to be financed by the bonds, the location, the owner of such
facility, the owner's EIN and the amount of available project proceeds to be used for that facility. (If more than one, attach schedule.)

E

Type of Facility:

Location of Facility:
Owner's Name:
Owner's EIN:
Amount of Available Project Proceeds $:

Schedule of Qualified Energy Conservation Bonds (QECBs)

Schedule B

©

Under Internal Revenue Code sections 54A and 54D
©

Part I
1
2
3
4
5
6

7
8
9
10

Tax Credit Bond Code

103

See separate instructions.

Issuer and Project Questions

Yes

Has the issuer designated these bonds as QECBs for purposes of section 54D? . . . . . .
Has the allocation been reallocated from a large local government to a State? . . . . . . .
Is the issuer a large local government? . . . . . . . . . . . . . . . . . . . .
Is the issuer an Indian tribal government? . . . . . . . . . . . . . . . . . . .
Are all proceeds to be used within the jurisdiction of the issuer? . . . . . . . . . . . .
If the issuer issued the bonds based on a volume cap allocation received by another authorized
entity (that allocated volume cap to the issue), provide the name of such authorized entity. Attach
schedule if more than one entity's volume cap is used (see instructions) . . . . . . . . .
.
.
.
.

.
.
.
.

.
.
.
.

.
.
.
.

.
.
.
.

.
.
.
.

.
.
.
.

.
.
.
.

.
.
.
.

.
.
.
.

.
.
.
.

.
.
.
.

.
.
.
.

.
.
.
.

.
.
.
.

.
.
.
.

.
.
.
.

.
.
.
.

.
.
.
.

.
.
.
.

.
.
.
.

.
.
.
.

.
.
.
.

.
.
.
.

.
.
.
.

.
.
.
.

.
.
.
.

.
.
.
.

.
.
.
.

.
.
.
.

.
.
.
.

.
.
.
.

.
.
.
.

No

1
2
3
4
5

6
7
8
9
10
Form 8038-TC (1-2010)

Version A, Cycle 4
Page 4

Form 8038-TC (1-2010)
Issuer's name:

Issuer's employer identification number (EIN):

Schedule B. Schedule of Qualified Energy Conservation Bonds (QECBs) (continued)
Part II
1
2
3
4
5
6
7
8
9
10

Part III
1

'

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.C

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

Part I

5
6
7
8
9
10

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

Amount
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
U
.

1
2
3
4
5
6
7
8
9
10

List the type of qualified conservation purpose described under section 54D(f) financed with the proceeds of the bonds, the
location of the facility financed with the proceeds of the bond, and the amount of available project proceeds to be used for the
qualified conservation purpose. If the bonds are private activity bonds, provide the name and EIN of the private user(s). (If the
issuer is issuing bonds for more than one purpose or facility attach schedule.)
Type of Qualified conservation purpose:
Location of facility financed with bond proceeds:
Amount of proceeds to be used for this purpose $:
Are the bonds private activity bonds? . . . . . . . . . . . . . . . . . . . . . . . ©
Yes
No
If Yes, provide name of private user(s)
Provide private users EIN

DRAFT AS OF
December 15, 2009

Tax Credit Bond Code

Schedule for Qualified Zone Academy Bonds (QZABs)
©

Under Internal Revenue Code sections 54A and 54E
©

4

.
.
.
.
.
.
.
.
.
.

List of conservation Purposes, Location of the Facilities, Amount of Proceeds used for the Purpose,
Private Activity User and Private User's EIN.

Schedule C

1
2
3

.
.
.
.
.
.
.
.
.
.

104

See separate instructions.

Academy Information

Yes

Is the school located in an empowerment zone? . . . . . . . . . . . . . . . . .
Is the school located in an enterprise community? . . . . . . . . . . . . . . . .
Is it expected that at least 35% of students attending the school or program will be eligible for free
or reduced-cost lunches under the school lunch program established by the National School Lunch
Act? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Was the comprehensive educational plan of the school or program approved by the eligible local
education agency? . . . . . . . . . . . . . . . . . . . . . . . . . . .
Is a carryover of unused limitation being used for this issue? If yes, enter the year in which the
limitation arose (See instructions.) ©
Are the bonds issued by a state or local government within the jurisdiction of which such academy
is located? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Does the issuer have written commitments from private business entities to make qualified private
business contributions having a present value of not less than 10% of the proceeds of this issue?
Was the bond issuance approved in writing by the eligible local education agency? . . .
Have these bonds been designated by the issuer as QZABs for purposes of section 54E? .
Enter the name of the eligible local education agency:

.
.

.
.

No

1
2

3
4
5
6
7
8
9
10
Form 8038-TC (1-2010)

Version A, Cycle 4
Page 5

Form 8038-TC (1-2010)
Issuer's name:

Issuer's employer identification number (EIN):

Schedule C. Schedule for Qualified Zone Academy Bonds (QZABs) (continued)
Part II
Description of the Private Business Contribution (enter the value of the amount of contribution in each
type)
Amount
1
2
3
4
5
6
7
8
9
10

Equipment . . . . . . . . . . . . .
Technical assistance . . . . . . . . . .
Services of donor's employees as volunteers . .
Opportunities for students outside of the academy
Other . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . .

Part III
1
2

Private Business Contributor Information

Part I

6
7

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

1
2
3
4
5
6
7
8
9
10

(attach a schedule if more than one donor)

Schedule for Qualified School Construction Bonds (QSCBs)
©

Tax Credit Bond Code

Under Internal Revenue Code sections 54A and 54F
©

5

.
.
.
.
.
.
.
.
.
.

Enter the name of the donor:
Enter the donor's EIN:

Schedule D

1
2
3
4

.
.
.
.
.
.
.
.
.
.

105

See separate instructions.

Use of Proceeds

Yes

Are the proceeds to be used for an Indian school? (See instructions.) . . . . . . . . . .
Are all proceeds to be used within the jurisdiction of the issuer? . . . . . . . . . . . .
Have these bonds been designated as QSCBs by the issuer for purposes of section 54F? . . .
Are the proceeds of the issue to be spent on costs of acquisition of equipment? If the answer is no,
skip 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Is such equipment to be used in portions of the public school facility being constructed,
rehabilitated, or repaired with the proceeds of the issue? . . . . . . . . . . . . . .
Are the proceeds of the issue to be spent on the costs of land acquisition? If the answer is no, skip
7? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Are proceeds of the issue also to be spent on the costs of construction of a public school facility on
such land? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DRAFT AS OF
December 15, 2009
4
5
6

8
9
10

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

.
.
.

7
8
9
10

1
2
3
4
5
6
7
8
9
10

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.

1
2
3
4
5
6
7
8
9
10

Part II

No

1
2
3

Amount

Form 8038-TC (1-2010)

Version A, Cycle 4
Page 6

Form 8038-TC (1-2010)
Issuer's name:

Issuer's employer identification number (EIN):

Schedule D. Schedule for Qualified School Construction Bonds (QSCBs) (continued)
Part III
Issuer Information (Does not apply to issuers that are Indian tribal governments.)
1

If the issuer of the bonds is not the local educational agency in the jurisdiction of which the public school facility is located,
please provide the name of such local educational agency. Attach schedule if more than one (see instructions)

2

If the issuer issued the bonds based on a volume cap allocation received by another authorized entity (that allocated volume
cap to the issue), provide the name of such authorized entity. Attach schedule if more than one entity's volume cap is used.
(see instructions)

Schedule for Qualified Zone Academy Bonds (QZABs)

Generic

©

Under Internal Revenue Code 149(e)
©

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

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

Part III

Tax Credit Bond Code

NNN

See separate instructions.

Questions

Yes

No

1
2
3
4
5
6
7
8
9
10

DRAFT AS OF
December 15, 2009

Amount

Other Information

1
2
3
4
5
6
7
8
9
10

1
2
3
Form 8038-TC (1-2010)