Form 8038 Information Return for Tax-Exempt Private Activity Bond

Form

8038

Information Return for Tax-Exempt
Private Activity Bond Issues

(Rev. January 2002)
Department of the Treasury
Internal Revenue Service

Part I

OMB No. 1545-0720

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

Reporting Authority

Check if Amended Return

1

Issuer’s name

3

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

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 or legal representative whom the IRS may call for more information

Room/suite

䊳

2

Issuer’s employer identification number

4

Report number

1

10

Telephone number of officer or legal representative

(

Part II
11
a
b
c
d
e
f

g
h

i
j
k
l
m
12
13
14
15
16
17
18
19
20

Type of Issue (check the applicable box(es) and enter the issue price for each)

Exempt facility bond:
Airport (sections 142(a)(1) and 142(c))
Docks and wharves (sections 142(a)(2) and 142(c))
Water furnishing facilities (sections 142(a)(4) and 142(e))
Sewage facilities (section 142(a)(5))
Solid waste disposal facilities (section 142(a)(6))
Qualified residential rental projects (sections 142(a)(7) and 142(d)), as follows:
Meeting 20–50 test (section 142(d)(1)(A))
Meeting 40–60 test (section 142(d)(1)(B))
Meeting 25–60 test (NYC only) (section 142(d)(6))
Has an election been made for deep rent skewing (section 142(d)(4)(B))?
Yes
No
Facilities for the local furnishing of electric energy or gas (sections 142(a)(8) and 142(f))
Facilities allowed under a transitional rule of the Tax Reform Act of 1986 (see instructions)
Facility type
1986 Act section
Qualified enterprise zone facility bonds (section 1394) (see instructions)
Qualified empowerment zone facility bonds (section 1394(f)) (see instructions)
District of Columbia Enterprise Zone facility bonds (section 1400A) (see instructions)
Qualified public educational facility bonds (sections 142(a)(13) and 142(k))
Other. Describe (see instructions) 䊳
Qualified mortgage bond (section 143(a))
Qualified veterans’ mortgage bond (section 143(b))
Check the box if you elect to rebate arbitrage profits to the United States
Qualified small issue bond (section 144(a)) (see instructions)
Check the box for $10 million small issue exemption
Qualified student loan bond (section 144(b))
Qualified redevelopment bond (section 144(c))
Qualified hospital bond (section 145(c)) (attach schedule—see instructions)
Qualified 501(c)(3) nonhospital bond (section 145(b)) (attach schedule—see instructions)
Check box if 95% or more of net proceeds will be used only for capital expenditures 䊳
Nongovernmental output property bond (treated as private activity bond) (section 141(d))
Other. Describe (see instructions) 䊳

Part III

Issue Price
11a
11b
11c
11d
11e
11f

11g
11h

䊳

11i
11j
11k
11l
11m
12
13

䊳

14
15
16
17
18
19
20

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

(a) Final maturity date

21

)

(b) Issue price

$

(c) Stated redemption
price at maturity

(d) Weighted
average maturity

$

For Paperwork Reduction Act Notice, see page 4 of the separate instructions.

(e) Yield

%

years
Cat. No. 49973K

Form

8038

(Rev. 1-2002)

Form 8038 (Rev. 1-2002)

Part IV
22
23
24
25
26
27
28
29
30

Page

Uses of Proceeds of Issue (including underwriters’ discount)

Amount
22
23

Proceeds used for accrued interest
Issue price of entire issue (enter amount from line 21, column (b))
Proceeds used for bond issuance costs (including underwriters’ discount) 24
25
Proceeds used for credit enhancement
26
Proceeds allocated to reasonably required reserve or replacement fund
27
Proceeds used to currently refund prior issue (complete Part VI)
28
Proceeds used to advance refund prior issue (complete Part VI)
Add lines 24 through 28
Nonrefunding proceeds of the issue (subtract line 29 from line 23 and enter amount here)

Part V

2

29
30

Description of Property Financed by Nonrefunding Proceeds
Caution: The total of lines 31a through e below must equal line 30 above. Do not complete for qualified student loan
bonds, qualified mortgage bonds, or qualified veterans’ mortgage bonds.

31
a
b
c
d
e
32

Type of Property Financed by Nonrefunding Proceeds:
31a
Land
31b
Buildings and structures
31c
Equipment with recovery period of more than 5 years
31d
Equipment with recovery period of 5 years or less
Other (describe)
31e
North American Industry Classification System (NAICS) of the projects financed by nonrefunding proceeds.
NAICS Code

a
b

Part VI
33
34
35
36

Amount of nonrefunding proceeds

$
$
Enter
Enter
Enter
Enter

Part VII

Amount of nonrefunding proceeds

NAICS Code

c
d

$
$

Description of Refunded Bonds (Complete this part only for refunding bonds.)
the
the
the
the

remaining weighted average maturity of the bonds to be currently refunded
remaining weighted average maturity of the bonds to be advance refunded
last date on which the refunded bonds will be called
date(s) the refunded bonds were issued 䊳

䊳
䊳

Miscellaneous
䊳

Name of governmental unit(s) approving issue (see the instructions)

38
39
40
41

䊳
Check the box if you have designated any issue under section 265(b)(3)(B)(i)(III)
䊳
Check the box if you have elected to pay a penalty in lieu of arbitrage rebate
䊳
Check the box if you have identified a hedge (see instructions)
Check the box if the issue is comprised of qualified redevelopment, qualified small issue, or exempt
䊳
facilities bonds and provide name and EIN of the primary private user
Name 䊳
EIN

Part VIII

b
c
d
45a
b
46a

years
years

䊳

37

42
43
44
a

Amount

Volume Caps

Amount

Amount of state volume cap allocated to the issuer. Attach copy of state certification
Amount of issue subject to the unified state volume cap
Amount of issue not subject to the unified state volume cap or other volume limitations:
Of bonds for governmentally owned solid waste facilities, airports, docks, wharves, environmental
enhancements of hydroelectric generating facilities, or high-speed intercity rail facilities
Under a carryforward election. Attach a copy of Form 8328 to this return
Under transitional rules of the Tax Reform Act of 1986. Enter Act section 䊳
Under the exception for current refunding (section 146(i) and section 1313(a) of the Tax Reform
Act of 1986)
Amount of issue of qualified veterans’ mortgage bonds
Enter the state limit on qualified veterans’ mortgage bonds
Amount of section 1394(f) volume cap allocated to issuer. Attach copy of local government certification

b Name of empowerment zone 䊳
47 Amount of section 142(k)(5) volume cap allocated to issuer. Attach copy of state certification.

42
43
44
44a
44b
44c
44d
45a
45b
46a
47

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

䊳

Signature of officer

Name of above officer (type or print)

䊳

Date

Title of officer (type or print)
Form

8038

(Rev. 1-2002)