Form 8038-CP Return for Credit Payments to Issuers of Qualified Bonds

Form

8038-CP

Return for Credit Payments
to Issuers of Qualified Bonds

(Rev. January 2012)
Department of the Treasury
Internal Revenue Service

Part I

Information on Entity That Is To Receive Payment of Credit and Communications

1

Name of entity that is to receive payment of the credit

3

Number and street (or P.O. box no. if mail is not delivered to street address)

4

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

5

Name and title of designated contact person whom the IRS may call for more information

Part II

OMB No. 1545-2142

2

Check box if Amended Return ▶

Employer identification number (EIN)
Room/suite

6

Telephone number of officer or legal representative

8

EIN

Reporting Authority

7

Issuer’s name (if same as line 1, enter “SAME” and skip lines 8, 9, 11, 15, and 16)

9

Number and street (or P.O. box no. if mail is not delivered to street address)

Room/suite

10

Report number (For IRS Use Only)

11

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

12

Date of issue (MM/DD/YYYY)

13

Name of issue

14

CUSIP number (see instructions)

15

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

16

Telephone number of officer or other person to call

17a

Type of issue ▶

For build America bonds and recovery zone economic development bonds, check the applicable box (see instructions)

b

Educational
Health and Hospital
Transportation
Public Safety
Environmental
Housing
For build America bonds, recovery zone economic development bonds, and specified tax credit bonds, enter
the issue price . . . . . . . . . . . . . . . . . . . . . . . . . . . . ▶
17b

c

Check applicable box ▶

Part III

Variable rate bond

Fixed rate bond

Interest payment date to which this payment of credit relates (MM/DD/YYYY)
Interest payable to bondholders on the interest payment date . . . . .

20

Amount of credit payment to be received as of the interest payment date (complete only line 20a, 20b, 20c, 20d, 20e, or 20f)

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19a

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For specified tax credit bonds only, enter the applicable credit rate determined under Sec. 54A(b)(3)

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%
For specified tax credit bonds only, enter the interest that would be payable to bondholders on the interest
payment date calculated using the applicable credit rate (see instructions) . . . . . . . . . . .

19c

a
b
c

Build America bonds. Multiply line 19a by 35% . . . . . . . . . . .
Recovery zone economic development bonds. Multiply line 19a by 45% . . . .
New clean renewable energy bonds enter the lesser of line 19a or 70% of line 19c .

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20a
20b
20c

d
e
f

Qualified energy conservation bonds enter the lesser of line 19a or 70% of line 19c
Qualified zone academy bonds enter the lesser of lines 19a or 19c . . . . .
Qualified school construction bonds enter the lesser of lines 19a or 19c . . . .

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20d
20e
20f

Adjustment to previous credit payments (complete line 21a OR line 21b only):
Net increase to previous payments (attach explanation) . . . . . . . .

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a
b
22
23
24

Other

Payment of Credit (For specified tax credit bonds with multiple maturities, see instructions.)

18
19a
b
c

21

Utilities

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Net decrease to previous payments (attach explanation) . . . . . . . . . . . . . . . .
Amount of credit payment to be received. Combine either line 20a, 20b, 20c, 20d, 20e, or 20f with line 21a or line 21b .
Is this the final interest payment date? . . . . . . . . . . . . . . . . . . . . . .
If the entity identified in Part I is not the issuer, check this box . . . . . . . . . . . . . . .

Direct
Deposit

Paid
Preparer
Use Only

a

Enter direct deposit information below:
Routing number

c

Account number

▶b

Type:

Checking

Yes
. .

No
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▶

Savings

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. I further declare that I authorize the IRS to send the requested refundable credit payment to the entity
identified in Part I, and I consent to the disclosure of the issuer’s return information, as necessary to process the refundable credit payment, to the
designated contact person(s) listed above in Parts I and II, as applicable.

▲

Signature
and
Consent

25

21a
21b
22
. . .
. . .

▶
Date

Signature of issuer

Print/Type preparer’s name

Preparer's signature

Type or print name and title
Date
PTIN
Check
if
self-employed

Firm’s name

▶

Firm's EIN

Firm's address

▶

Phone no.

For Paperwork Reduction Act Notice, see the separate instructions.

Cat. No. 52810E

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Form 8038-CP (Rev. 1-2012)