Fillable F14429 Form 14429 (Rev. 2-2020)

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F14429 Form 14429 (Rev. 2-2020)

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Catalog Number 60719A www.irs.gov
Form
14429 (Rev. 2-2020)
Form 14429
(February 2020)
Department of the Treasury - Internal Revenue Service
Tax Exempt Bonds
Voluntary Closing Agreement Program Request
The Tax Exempt Bonds Voluntary Closing Agreement Program (TEB VCAP), described in Notice 2008-31, 2008-11 I.R.B. 592,
provides remedies for issuers of tax-advantaged bonds who voluntarily come forward to resolve a violation of the federal tax
requirements that apply to a bond issue that cannot be corrected under self-correction programs described in the Income Tax
Regulations or other published guidance. For this purpose, references to “tax-advantaged bonds” include tax-exempt bonds, qualified
tax credit bonds and direct pay bonds, which are specified tax credit bonds, build America bonds and recovery zone economic
development bonds. Internal Revenue Manual (IRM) Section 7.2.3 provides additional guidance on how to submit a TEB VCAP
request.
Purpose of this form
This form is to assist issuers in submitting a complete and organized TEB VCAP submission request. It does not alter the requirements
of Internal Revenue Code (IRC) Section 7121, Notice 2008-31 or IRM 7.2.3.
Who may use this form
A tax-advantaged bonds issuer may submit a TEB VCAP request to resolve a violation jeopardizing the tax-advantaged status of its
bonds. While other parties (for example, conduit borrower, trustee) may participate in a TEB VCAP request with the permission of the
issuer, only the issuer may use this form to submit a request.
How to use this form
Answer each question by filling in the requested information in the corresponding box. If the question relates to information to be
included in the request, check the appropriate Yes or N/A option. When a question contains a place for a page number, insert the page
number(s) of the request that correspond to the information called for by a “Yes” answer. The term violation in this form includes
multiple violations if more than one violation is identified in the submission. Sign the form under penalty of perjury, date the form and
include it at the beginning of your request.
Issuer Information
See IRM 7.2.3, Exhibit 7.2.3-1, item (a)
1. Issuer's name 2. Issuer's employer identification number (EIN)
3. Is the issuer’s name and EIN different than reported on the Form 8038 series information return filed upon the bond issuance
Yes N/A
If Yes, provide the name and EIN reported on the return
Name EIN
4. Issuer’s address (number, street)
City State ZIP Code
5. Name and title of issuer's official who may be contacted for additional information
6. Telephone number of official listed on line 5
Note: For a violation that affects multiple issuers or bond issues, such as a composite issue, absent extraordinary circumstances, each
issuer of an affected issue must join in the request and provide the information required in lines 1 - 6 in an attached schedule. In
the case of extraordinary circumstances, the issuer may submit an explanation for this request and forgo supplying information
about the other issuers and affected issues, but the IRS may determine that this information is necessary.
Page 2
Catalog Number 60719A www.irs.gov
Form
14429 (Rev. 2-2020)
Additional Party Information
If the issuer proposes to include additional parties to the closing agreement provide
7. Additional party’s name 8. Additional party’s EIN
9. Address (number, street)
City ZIP CodeState
10. Name and title of additional party's official who may be contacted for additional information
11. Telephone number of official listed on line 10
12. Role of additional party (for example, conduit borrower, trustee)
13. Is Form 8821, Tax Information Authorization, attached for the additional party to inspect and receive information about the issuer
(IRM 7.2.3.2.1(4))
Yes
Page number
N/A
14. Is Form 8821 attached for the issuer to inspect and receive information about the additional party (IRM 7.2.3.2.1(4))
Yes
Page number
N/A
Note: If more than one additional party, provide the Forms 8821 and information required in lines 7 - 14 for each additional party on an
attached schedule.
Authorized Representative Information
15. Is Form 2848, Power of Attorney and Declaration of Representative, for each authorized representative attached (IRM 7.2.3.2.1(4))
Yes
Page number
N/A
16. Authorized representative's name and title 17. PTIN of authorized representative
18. Address (number, street)
City State ZIP Code
19. Telephone number of authorized representative
Note: If more than one authorized representative, provide the Forms 2848 and information required in lines 16 - 19 for each additional
representative on an attached schedule.
Bond Information
See IRM 7.2.3, Exhibit 7.2.3-1, item (b)
20. Name of bond issue 21. Issue date
22. CUSIP number (if any) reported on Form 8038 series information return filed for the bond issue
23. Issue price
24. Is a full debt service schedule for the issue showing principal maturities and interest rates (for variable rate issues include a
description of how the rate is set and the interest payments to the date of the request) attached
Yes
Page number
N/A
25. Is a copy of the Form 8038 series information return filed with the IRS for the bond issue attached (IRM 7.2.3.2.1(3))
Yes
Page number
N/A
Page 3
Catalog Number 60719A www.irs.gov
Form
14429 (Rev. 2-2020)
26. If the request relates to a direct pay bond issue, is a copy of any Forms 8038-CP related to the bond issue and submitted to the IRS
attached (IRM 7.2.3.2.1(3))
Yes
Page number
N/A
27. If the violation relates to the requirements of IRC Section 148, is a copy of any Forms 8038-T and Forms 8038-R related to the bond
issue and submitted to the IRS attached (IRM 7.2.3.2.1(3))
Yes
Page number
N/A
Violation
See IRM 7.2.3, Exhibit 7.2.3-1, item (c)
28. Which IRC Sections relate to the violation described in the request
Section
29. Is a clear statement included that describes the specific federal tax requirement that provides a basis for finding a violation
Yes
Page number
N/A
30. Is a description included that describes the identified violation and the facts and circumstances of the nature and occurrence of the
identified violation
Yes
Page number
N/A
31. Is a statement included that describes when and how the identified violation was discovered
Yes
Page number
N/A
32. If the issuer requests TEB consider lack of clarity about certain legal questions as a factor in determining an appropriate resolution
is the following included
a) A description of established law supporting a determination that there is a credible basis for finding that a violation occurred
Yes
Page number
N/A
b) A description of the legal questions, and their application to the facts of the submission, supporting why TEB should consider the
legal questions as a factor in the appropriate resolution of the violation
Yes
Page number
N/A
33. If the issuer is submitting a request to resolve a violation using a resolution standard described in IRM 7.2.3.4.3 (Identified
Violations - Tax Exempt Bonds) or IRM 7.2.3.4.4 (Identified Violations - Certain Direct Pay Bonds), has the issuer supplied
information required under the relevant Identified Violation section
Yes
Page number
N/A
Settlement Terms
See IRM 7.2.3, Exhibit 7.2.3-1, item (d)
34. Has the issuer included a description of the proposed settlement terms for resolving the identified violation
Yes
Page number
N/A
35. Has the issuer included a draft closing agreement based on the VCAP Model Agreement (See IRM 7.2.3.2.1(5))
Yes
Page number
N/A
36. If the proposal includes the payment of a closing agreement amount, has the issuer included an identification of
a) The computation methodology described in IRM 4.81.6 used to determine the amount or a description of an alternative
computation methodology including a discussion of why the alternative is appropriate in this case
Yes
Page number
N/A
b) The source of funds to be used to pay the closing agreement amount
Yes
Page number
N/A
37. If the proposal includes the redemption, defeasance, tender or purchase of any amount of the bonds comprising the bond issue,
has the issuer identified the source of funds to be used to complete the action and the maturities of the bonds subject to the action
Yes
Page number
N/A
Statements of Good Faith
See IRM 7.2.3, Exhibit 7.2.3-1, item (e)
38. Has the issuer included a statement that the bond issue is not under examination or under consideration by the IRS Independent
Office of Appeals
Yes
Page number
N/A
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Catalog Number 60719A www.irs.gov
Form
14429 (Rev. 2-2020)
39. Has the issuer included a statement that the tax-advantaged status of the bonds is not at issue in any federal court
Yes
Page number
N/A
40. Has the issuer included a statement as to whether the bonds are under review in any court (other than a federal court),
administrative agency, commission or other proceeding (and identified the proceeding)
Yes
Page number
N/A
41. Has the issuer included a statement as to whether on the issue date the issuer knew or reasonably expected that the violation might
occur
Yes
Page number
N/A
42. Has the issuer included the date(s) of the violation, the date and circumstances surrounding the discovery of the violation and the
date and nature of any actions taken in response to the discovery of the violation (for example, redemption or defeasance)
Yes
Page number
N/A
Identification of Previous TEB VCAP or Private Letter Ruling Requests
See IRM 7.2.3, Exhibit 7.2.3-1, items (f) and (g)
43. Has the issuer either identified any TEB VCAP requests (including anonymous requests for which a response was received, but no
closing agreement executed) previously or contemporaneously submitted: (1) with respect to the bond issue that is the subject of
the request; or (2) pertaining to a violation that is of the same type as the subject of the request provided that such request was
submitted within the past five years, including the name(s) of the related bond issue(s), brief summary of the violation(s) identified
and resolution thereof; or included a statement that no such TEB VCAP requests have been or are being submitted
Yes
Page number
N/A
44. Has the issuer identified all private letter ruling requests previously or contemporaneously submitted by the issuer with respect to
the bonds and related to the violation which is the subject of the TEB VCAP request, including a brief summary of the matters
addressed therein; or included a statement that no such private letter ruling requests have been or are being submitted
Yes
Page number
N/A
Disclosure, Third Party Fault, Other
See IRM 7.2.3, Exhibit 7.2.3-1, items (h), (i) and (j)
45. Has the issuer disclosed the potential violation on the Municipal Securities Rulemaking Board’s Electronic Municipal Market Access
System, known as EMMA, or to any state or local taxing jurisdiction that grants tax-advantaged treatment to the issuer’s bonds and,
if so, included a statement describing the disclosure and how it was made or if no disclosure has been made, included a statement
to that effect
Yes
Page number
N/A
46. If the issuer wishes to assert that the violation was caused by another party and requests TEB to consider this as a factor in
determining an appropriate resolution, has the issuer included a statement that the violation was due to the acts or omissions of a
person or persons other than the issuer, together with a description of the circumstances surrounding the violation, and any
information that the issuer has regarding the acts or omissions (including an identification of the person or persons whose acts or
omissions caused the violation)
Yes
Page number
N/A
47. Has the issuer attached an explanation of any other information relevant to matters contained in, or resolution of, the TEB VCAP
request
Yes
Page number
N/A
Issuer Approval and Signature
Under penalties of perjury, I declare that I have examined this submission, including accompanying documents and statements, and to
the best of my knowledge and belief, the submission contains all the relevant facts relating to the request, and such facts are true,
correct and complete
Signature of Official of Issuer Name of Official of Issuer Date signed
Note: TEB will only accept facts submitted by a party other than the issuer (for example, conduit borrower, trustee) under penalties of
perjury if the issuer also certifies under penalties of perjury that to the best of the issuer’s knowledge the facts are true and accurate. If
the issuer wishes to have another party submit facts under penalty of perjury, attach a separate penalty of perjury statement.
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F14429 Form 14429 (Rev. 2-2020)

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Completed 10 June 2020

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