Form 8038-G Information Return for Tax-Exempt Governmental Obligatio

Form

8038-G

Information Return for Tax-Exempt Governmental Obligations
䊳

Under Internal Revenue Code section 149(e)
䊳 See separate Instructions.
Caution: If the issue price is under $100,000, use Form 8038-GC.

(Rev. November 2000)
Department of the Treasury
Internal Revenue Service

Reporting Authority

Part I

OMB No. 1545-0720

If Amended Return, check here

䊳

1

Issuer’s name

2 Issuer’s employer identification number

3

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

Room/suite

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 10 Telephone number of officer or legal representative

4 Report number

3

(

Part II
11
12
13
14
15
16
17
18
19
20

Education
Health and hospital
Transportation
Public safety
Environment (including sewage bonds)
Housing
Utilities
Other. Describe 䊳
If obligations are TANs or RANs, check box 䊳
If obligations are BANs, check box
If obligations are in the form of a lease or installment sale, check box

Part III

21
22
23
24
25
26
27
28
29
30

38
39
40

䊳
䊳

(d) Weighted
average maturity

(e) Yield

years

$

Enter
Enter
Enter
Enter

%

Uses of Proceeds of Bond Issue (including underwriters’ discount)
22
23

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

Part VI
35
36a
b
37
b

(c) Stated redemption
price at maturity

(b) Issue price

$

Part V
31
32
33
34

11
12
13
14
15
16
17
18

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

(a) Final maturity date

Part IV

)

Type of Issue (check applicable box(es) and enter the issue price) See instructions and attach schedule

29
30

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

years
years

䊳
䊳
䊳

Miscellaneous

35
Enter the amount of the state volume cap allocated to the issue under section 141(b)(5)
36a
Enter the amount of gross proceeds invested or to be invested in a guaranteed investment contract (see instructions)
Enter the final maturity date of the guaranteed investment contract 䊳
37a
Pooled financings: a Proceeds of this issue that are to be used to make loans to other governmental units
If this issue is a loan made from the proceeds of another tax-exempt issue, check box 䊳
and enter the name of the
issuer 䊳
and the date of the issue 䊳
䊳
If the issuer has designated the issue under section 265(b)(3)(B)(i)(III) (small issuer exception), check box
䊳
If the issuer has elected to pay a penalty in lieu of arbitrage rebate, check box
䊳
If the issuer has identified a hedge, 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

䊳

Signature of issuer’s authorized representative

Date

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

䊳

Type or print name and title

Cat. No. 63773S

Form

8038-G

(Rev. 11-2000)