8038-B (2017 Draft Information Return for Build America Bonds and Recovery

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Form

8038-B

(Rev. September 2017)
Department of the Treasury
Internal Revenue Service

Part I

Information Return for Build America Bonds and Recovery Zone
Economic Development Bonds

OMB No. 1545-0720

Under Internal Revenue Code section 149(e)
▶ See separate instructions.
▶ Go to www.irs.gov/Form8038B for instructions and the latest information.
▶

Check if Amended Return ▶

Reporting Authority

1

Issuer’s name

3

Name of person (other than issuer) with whom the IRS may communicate about this return (see instructions)

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 (MM/DD/YYYY)

8

Name of issue

9 CUSIP number

2 Issuer’s employer identification number (EIN)

DRAFT AS OF
April 24, 2017
DO NOT FILE

4 Report number (For IRS Use Only)
1

10

1a
b
c
2
3
a
b
c
d
e
f

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a
b
c
d
e
f
g
h
2
a
b
c
d

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Purpose of Issue

For a build America bond, identify the purpose of issue and enter the issue price. See instructions
and attach schedule.

1

Education . . . . . . . . . . . .
Health and hospital . . . . . . . .
Transportation . . . . . . . . . .
Public safety . . . . . . . . . . .
Environment (including sewage bonds) . .
Housing . . . . . . . . . . . .
Utilities . . . . . . . . . . . . .
Other description ▶
For a recovery zone economic development
price. See instructions and attach schedule.

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Amount
(Whole Dollars)

1a
1b
1c
1d
1e
1f
1g
1h

bond, identify the purpose of issue and enter the issue

2a
Capital expenditures relating to property located in the zone . . . . . . . . . . . . .
2b
Public infrastructure and construction of public facilities . . . . . . . . . . . . . .
Job training and educational programs . . . . . . . . . . . . . . . . . . . .
2c
Other description . . . . . . . . . . . . . . . . . . . . . . . . . . .
2d
Total issue price (Part III, lines 1a through 1h or lines 2a through 2d) . . . . . . . . . .
3
If obligations are TANs or RANs, check only box 4a ▶
If obligations are BANs, check only box 4b ▶
If obligations are in the form of a lease or installment sale, check box ▶

Part IV
1
2
3
4
5

Type of Bonds (see instructions, if the box on line 1b or 1c is checked, complete lines 2 and 3)

Build America bonds (Tax Credit) (section 54AA(a)) . . . . . . . . . . . . . . . .
Build America bonds (Direct Payment) (sections 54AA(g) and 6431) . . . . . . . . . . .
Recovery zone economic development bonds (Direct Payment) (sections 1400U-2 and 6431) . .
Enter the first interest payment date (MM/DD/YYYY) ▶
/
/
Interest payment date frequency: (Check box) (see instructions and attach debt service schedule)
annual,
semi-annual,
quarterly,
monthly, or
other
If line 3e above is checked, please describe the payment frequency:

Part III

/

11 Telephone number of officer or other person (see instructions)

Name and title of officer of issuer whom the IRS may call for more information (see instructions)

Part II

3
4
5

/

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

Stated redemption price at maturity . . . . .
Final maturity date (MM/DD/YYYY) . . . . .
Weighted average maturity . . . . . . . .
Yield . . . . . . . . . . . . . . .
If the issue is a variable rate issue, check box 5a ▶

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1
. . . . . . . .
/
/
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. . . . .
years
.
%
. . .
Please indicate the frequency rates are reset 5b ▶

For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.

Cat. No. 53393K

Form 8038-B (Rev. 9-2017)

Page 2

Form 8038-B (Rev. 9-2017)

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

2
3
4

Use of Proceeds of Issue

Sales proceeds . . . . . . . . . . . . . . . . . . .
Expected investment proceeds
. . . . . . . . . . . . .
Proceeds used for accrued interest . . . . . . . . . . . .
Proceeds used for bond issuance cost (including underwriter's discount)
Proceeds used for credit enhancement . . . . . . . . . . .
Proceeds allocated to a reasonably required reserve fund . . . . .
Proceeds used for capital expenditures . . . . . . . . . . .
Proceeds used for working capital expenditures . . . . . . . .
Proceeds used to currently refund prior issues
. . . . . . . .
Proceeds used to advance refund prior issues
. . . . . . . .

Part VI
1

Amount
(Whole Dollars)

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1
2
3
4
5
6
7
8
9
10

DRAFT AS OF
April 24, 2017
DO NOT FILE

Description of Refunded Bonds (complete this part only for refunding bonds)

Enter the remaining weighted average maturity of the bonds to be
years
currently refunded . . . . . . . . . . . . . . . . .
Enter the remaining weighted average maturity of the bonds to be
years
advance refunded . . . . . . . . . . . . . . . . .
Enter the last date on which the refunded bonds will be called (MM/DD/YYYY)
/
/
Enter the date the refunded bonds were issued (if more than one date of issue, attach a schedule)
(MM/DD/YYYY) (see instructions) . . . . . . . . . . . .
/
/

Part VII

Miscellaneous

1
Enter the amount of the volume cap allocated to the issue (see instructions) (attach volume cap certification)
1
2 a Enter the amount of gross proceeds invested or to be invested in a guaranteed investment contract
(GIC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2a
b Enter the final maturity date of the GIC (MM/DD/YYYY) ▶
/
/
c Enter the name of the GIC provider ▶
3
Proceeds of this issue that are to be used to make loans to other governmental units . . . . .
3
4 a If this issue is a loan made from the proceeds of another issue, check box ▶
and enter the following information:
b Enter the issue date of the master pool obligation (MM/DD/YYYY) ▶
/
/
c Enter the EIN of the issuer of the master pool obligation ▶
d Enter the name of the issuer of the master pool obligation ▶
5 a If the issuer entered into a hedge, check box ▶
and enter the following information:
b Name of hedge provider ▶
c Type of hedge ▶
d Term of hedge ▶
6
If the issuer has superintegrated the hedge, check box ▶
7
If the issuer elected to pay a penalty in lieu of arbitrage rebate, check box ▶
If the issuer has established written procedures to ensure that all nonqualified bonds of this issue are remediated in accordance
8
with the requirements under Regulations section 1.141-12, check box ▶
9

If the issuer has established written procedures to monitor the requirements of section 148, check box ▶

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

▲

1

Preparer’s
signature

Date

Type or print name and title
Check if
selfemployed

Date

▲

Part VIII

Signature of issuer's authorized representative
▲

Paid
Preparer’s
Use Only

▲

Signature
and
Consent

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 consent to the IRS's disclosure of the issuer's return information, as necessary to process
the return, to the person(s) that I have authorized above.

Preparer’s SSN or PTIN

EIN

Consent to Disclosure of Certain Information From This Return

Phone no.

For build America bonds that provide a tax credit to bondholders, does the issuer give the IRS consent to publish, through a
website or in a publication, its name and address, employer identification number, name and description of bond issue, date of
issuance, CUSIP number, issue price, final maturity date, and stated redemption price at maturity, to assist in the proper reporting
of interest, tax credits, or other benefits under 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 items of information described in line 1 of Part VIII of this form to assist in the reporting obligations under section 6049.

Signature

Date

▲

▲

Sign
Here

Type or print name and title
Form 8038-B (Rev. 9-2017)