Fill - Free fillable Form 8038-GC 2012 Information Return PDF form

Form 8038-GC

(Rev. January 2012)

Department of the Treasury

Internal Revenue Service

Information Return for Small Tax-Exempt

Governmental Bond Issues, Leases, and Installment Sales

▶

Under Internal Revenue Code section 149(e)

Caution: If the issue price of the issue is $100,000 or more, use Form 8038-G.

OMB No. 1545-0720

Part I Reporting Authority

Check box if Amended Return

▶

1 Issuer’s name 2

Issuer’s employer identification number (EIN)

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

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

5 Report number (For IRS Use Only)

6 Name and title of officer or other employee of issuer or designated contact person whom the IRS may call for more information

Telephone number of officer or legal representative

Part II Description of Obligations

Check one: a single issue

or a consolidated return .

8a Issue price of obligation(s) (see instructions) . . . . . . . . . . . . . . . . . . 8a

Issue date (single issue) or calendar date (consolidated). Enter date in mm/dd/yyyy format (for

example, 01/01/2009) (see instructions)

▶

9 Amount of the reported obligation(s) on line 8a that is:

a For leases for vehicles . . . . . . . . . . . . . . . . . . . . . . . . .

b For leases for office equipment . . . . . . . . . . . . . . . . . . . . . . . 9b

c For leases for real property . . . . . . . . . . . . . . . . . . . . . . . . 9c

d For leases for other (see instructions) . . . . . . . . . . . . . . . . . . . . . 9d

e For bank loans for vehicles . . . . . . . . . . . . . . . . . . . . . . . . 9e

f For bank loans for office equipment . . . . . . . . . . . . . . . . . . . . . 9f

g For bank loans for real property. . . . . . . . . . . . . . . . . . . . . . . 9g

h For bank loans for other (see instructions) . . . . . . . . . . . . . . . . . . . 9h

i Used to refund prior issue(s) . . . . . . . . . . . . . . . . . . . . . . . 9i

Representing a loan from the proceeds of another tax-exempt obligation (for example, bond bank) . .

k Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9k

10 If the issuer has designated any issue under section 265(b)(3)(B)(i)(III) (small issuer exception), check this box . . . .

▶

11 If the issuer has elected to pay a penalty in lieu of arbitrage rebate, check this box (see instructions) . . . . . . .

▶

12 Vendor’s or bank’s name:

Vendor’s or bank’s employer identification number:

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 this return, to the person(s)

that I have authorized above.

▲

Signature of issuer’s authorized representative

Date

▲

Type or print name and title

Paid

Preparer

Use Only

Print/Type preparer’s name Preparer's signature Date

Check if

self-employed

PTIN

Firm’s name

▶

Firm's address

▶

Firm's EIN

▶

Phone no.

General Instructions

Section references are to the Internal Revenue

Code unless otherwise noted.

What's New

The IRS has created a page on IRS.gov for

information about the Form 8038 series and

its instructions, at www.irs.gov/form8038.

Information about any future developments

affecting the Form 8038 series (such as

legislation enacted after we release it) will be

posted on that page.

Purpose of Form

Form 8038-GC is used by the issuers of tax-

exempt governmental obligations to provide

the IRS with the information required by

section 149(e) and to monitor the

requirements of sections 141 through 150.

Who Must File

Issuers of tax-exempt governmental

obligations with issue prices of less than

$100,000 must file Form 8038-GC.

Issuers of a tax-exempt governmental

obligation with an issue price of $100,000 or

more must file Form 8038-G, Information

Return for Tax-Exempt Governmental

Obligations.

Filing a separate return for a single issue.

Issuers have the option to file a separate

Form 8038-GC for any tax-exempt

governmental obligation with an issue price

of less than $100,000.

An issuer of a tax-exempt bond used to

finance construction expenditures must file a

separate Form 8038-GC for each issue to give

notice to the IRS that an election was made to

pay a penalty in lieu of arbitrage rebate (see

the line 11 instructions).

Filing a consolidated return for multiple

issues. For all tax-exempt governmental

obligations with issue prices of less than

$100,000 that are not reported on a separate

Form 8038-GC, an issuer must file a

consolidated information return including all

such issues issued within the calendar year.

Thus, an issuer may file a separate Form

8038-GC for each of a number of small issues

and report the remainder of small issues

issued during the calendar year on one

consolidated Form 8038-GC. However, if the

issue is a construction issue, a separate Form

8038-GC must be filed to give the IRS notice

of the election to pay a penalty in lieu of

arbitrage rebate.

Cat. No. 64108B

Form 8038-GC (Rev. 1-2012)

Page 2

When To File

To file a separate return for a single issue, file

Form 8038-GC on or before the 15th day of

the second calendar month after the close of

the calendar quarter in which the issue is

issued.

To file a consolidated return for multiple

issues, file Form 8038-GC on or before

February 15th of the calendar year following

the year in which the issue is issued.

Late filing. An issuer may be granted an

extension of time to file Form 8038-GC under

section 3 of Rev. Proc. 2002-48, 2002-37

I.R.B. 531, if it is determined that the failure to

file on time is not due to willful neglect. Type

or print at the top of the form, “Request for

Relief under section 3 of Rev. Proc. 2002-48.”

Attach to the Form 8038-GC a letter briefly

stating why the form was not submitted to the

IRS on time. Also indicate whether the

obligation in question is under examination by

the IRS. Do not submit copies of any bond

documents, leases, or installment sale

documents. See Where To File next.

Where To File

File Form 8038-GC, and any attachments,

with the Department of the Treasury, Internal

Revenue Service Center, Ogden, UT 84201.

Private delivery services. You can use

certain private delivery services designated by

the IRS to meet the “timely mailing as timely

filing/paying” rule for tax returns and

payments. These private delivery services

include only the following:

• DHL Express (DHL): DHL Same Day Service.

• Federal Express (FedEx): FedEx Priority

Overnight, FedEx Standard Overnight, FedEx

2Day, FedEx International Priority, and FedEx

International First.

• United Parcel Service (UPS): UPS Next Day

Air, UPS Next Day Air Saver, UPS 2nd Day

Air, UPS 2nd Day Air A.M., UPS Worldwide

Express Plus, and UPS Worldwide Express.

The private delivery service can tell you

how to get written proof of the mailing date.

Other Forms That May Be

Required

For rebating arbitrage (or paying a penalty in

lieu of arbitrage rebate) to the Federal

Government, use Form 8038-T, Arbitrage

Rebate, Yield Reduction and Penalty in Lieu

of Arbitrage Rebate. For private activity

bonds, use Form 8038, Information Return for

Tax-Exempt Private Activity Bond Issues.

For a tax-exempt governmental obligation

with an issue price of $100,000 or more, use

Form 8038-G.

Rounding to Whole Dollars

You may show the money items on this return

as whole-dollar amounts. To do so, drop any

amount less than 50 cents and increase any

amount from 50 to 99 cents to the next higher

dollar.

Definitions

Obligations. This refers to a single tax-

exempt governmental obligation if Form

8038-GC is used for separate reporting or to

multiple tax-exempt governmental obligations

if the form is used for consolidated reporting.

Tax-exempt obligation. This is any obligation

including a bond, installment purchase

agreement, or financial lease, on which the

interest is excluded from income under

section 103.

Tax-exempt governmental obligation. A

tax-exempt obligation that is not a private

activity bond (see below) is a tax-exempt

governmental obligation. This includes a bond

issued by a qualified volunteer fire department

under section 150(e).

Private activity bond. This includes an

obligation issued as part of an issue in which:

• More than 10% of the proceeds are to be

used for any private activity business use, and

• More than 10% of the payment of principal

or interest of the issue is either (a) secured by

an interest in property to be used for a private

business use (or payments for such property)

or (b) to be derived from payments for

property (or borrowed money) used for a

private business use.

It also includes a bond, the proceeds of

which (a) are to be used to make or finance

loans (other than loans described in section

141(c)(2)) to persons other than governmental

units and (b) exceeds the lesser of 5% of the

proceeds or $5 million.

Issue. Generally, obligations are treated as

part of the same issue only if they are issued

by the same issuer, on the same date, and as

part of a single transaction, or a series of

related transactions. However, obligations

issued during the same calendar year (a)

under a loan agreement under which amounts

are to be advanced periodically (a “draw-

down loan”) or (b) with a term not exceeding

270 days, may be treated as part of the same

issue if the obligations are equally and ratably

secured under a single indenture or loan

agreement and are issued under a common

financing arrangement (for example, under the

same official statement periodically updated

to reflect changing factual circumstances).

Also, for obligations issued under a draw-

down loan that meets the requirements of the

preceding sentence, obligations issued during

different calendar years may be treated as

part of the same issue if all of the amounts to

be advanced under the draw-down loan are

reasonably expected to be advanced within 3

years of the date of issue of the first

obligation. Likewise, obligations (other than

private activity bonds) issued under a single

agreement that is in the form of a lease or

installment sale may be treated as part of the

same issue if all of the property covered by

that agreement is reasonably expected to be

delivered within 3 years of the date of issue of

the first obligation.

Arbitrage rebate. Generally, interest on a

state or local bond is not tax-exempt unless

the issuer of the bond rebates to the United

States arbitrage profits earned from investing

proceeds of the bond in higher yielding

nonpurpose investments. See section 148(f).

Construction issue. This is an issue of tax-

exempt bonds that meets both of the

following conditions:

1. At least 75% of the available construction

proceeds of the issue are to be used for

construction expenditures with respect to

property to be owned by a governmental unit

or a 501(c)(3) organization, and

2. All of the bonds that are part of the issue

are qualified 501(c)(3) bonds, bonds that are

not private activity bonds, or private activity

bonds issued to finance property to be owned

by a governmental unit or a 501(c)(3)

organization.

In lieu of rebating any arbitrage that may be

owed to the United States, the issuer of a

construction issue may make an irrevocable

election to pay a penalty. The penalty is equal

to 1-1/2% of the amount of construction

proceeds that do not meet certain spending

requirements. See section 148(f)(4)(C) and the

Instructions for Form 8038-T.

Specific Instructions

In general, a Form 8038-GC must be

completed on the basis of available

information and reasonable expectations as of

the date of issue. However, forms that are

filed on a consolidated basis may be

completed on the basis of information readily

available to the issuer at the close of the

calendar year to which the form relates,

supplemented by estimates made in good

faith.

Part I—Reporting Authority

Amended return. An issuer may file an

amended return to change or add to the

information reported on a previously filed

return for the same date of issue. If you are

filing to correct errors or change a previously

filed return, check the “Amended Return” box

in the heading of the form.

The amended return must provide all the

information reported on the original return, in

addition to the new corrected information.

Attach an explanation of the reason for the

amended return and write across the top

"Amended Return Explanation."

Line 1. The issuer’s name is the name of the

entity issuing the obligations, not the name of

the entity receiving the benefit of the

financing. In the case of a lease or installment

sale, the issuer is the lessee or purchaser.

Line 2. An issuer that does not have an

employer identification number (EIN) should

apply for one on Form SS-4, Application for

Employer Identification Number. You can get

this form on the IRS website at IRS.gov or by

calling 1-800-TAX-FORM (1-800-829-3676).

You may receive an EIN by telephone by

following the instructions for Form SS-4.

Lines 3 and 4. Enter the issuer’s address or

the address of the designated contact person

listed on line 6. If the issuer wishes to use its

own address and the issuer receives its mail

in care of a third party authorized

representative (such as an accountant or

attorney), enter on the street address line

“C/O” followed by the third party's name and

street address or P.O. box. Include the suite,

room, or other unit number after the street

address. If the post office does not deliver

mail to the street address and the issuer has a

P.O. box, show the box number instead of the

Form 8038-GC (Rev. 1-2012)

Page 3

street address. If a change in address occurs

after the return is filed, use Form 8822,

Change of Address, to notify the IRS of the

new address.

Note. The address entered on lines 3 and 4 is

the address the IRS will use for all written

communications regarding the processing of

this return, including any notices. By

authorizing a person other than an authorized

officer or other employee of the issuer to

communicate with the IRS and whom the IRS

may contact about this return, the issuer

authorizes the IRS to communicate directly

with the individual listed on line 6, whose

address is entered on lines 3 and 4 and

consents to disclose the issuer's return

information to that individual, as necessary, to

process this return.

Line 5. This line is for IRS use only. Do not

make any entries in this box.

Part II—Description of Obligations

Check the appropriate box designating this as

a return on a single issue basis or a

consolidated return basis.

Line 8a. The issue price of obligations is

generally determined under Regulations

section 1.148-1(b). Thus, when issued for

cash, the issue price is the price at which a

substantial amount of the obligations are sold

to the public. To determine the issue price of

an obligation issued for property, see sections

1273 and 1274 and the related regulations.

Line 8b. For a single issue, enter the date of

issue (for example, 03/15/2010 for a single

issue issued on March 15, 2010), generally

the date on which the issuer physically

exchanges the bonds that are part of the

issue for the underwriter’s (or other

purchaser’s) funds; for a lease or installment

sale, enter the date interest starts to accrue.

For issues reported on a consolidated basis,

enter the first day of the calendar year during

which the obligations were issued (for

example, for calendar year 2010, enter

01/01/2010).

Lines 9a through 9h. Complete this section if

property other than cash is exchanged for the

obligation, for example, acquiring a police car,

a fire truck, or telephone equipment through a

series of monthly payments. (This type of

obligation is sometimes referred to as a

“municipal lease.”) Also complete this section

if real property is directly acquired in

exchange for an obligation to make periodic

payments of interest and principal.

Do not complete lines 9a through 9d if the

proceeds of an obligation are received in the

form of cash even if the term “lease” is used

in the title of the issue. For lines 9a through

9d, enter the amount on the appropriate line

that represents a lease or installment

purchase. For line 9d, enter the type of item

that is leased. For lines 9e through 9h, enter

the amount on the appropriate line that

represents a bank loan. For line 9h, enter the

type of bank loan.

Lines 9i and 9j. For line 9i, enter the amount

of the proceeds that will be used to pay

principal, interest, or call premium on any

other issue of bonds, including proceeds that

will be used to fund an escrow account for

this purpose. Several lines may apply to a

particular obligation. For example, report on

lines 9i and 9j obligations used to refund prior

issues which represent loans from the

proceeds of another tax-exempt obligation.

Line 9k. Enter on line 9k the amount on line

8a that does not represent an obligation

described on lines 9a through 9j.

Line 10. Check this box if the issuer has

designated any issue as a “small issuer

exception” under section 265(b)(3)(B)(i)(III).

Line 11. Check this box if the issue is a

construction issue and an irrevocable election

to pay a penalty in lieu of arbitrage rebate has

been made on or before the date the bonds

were issued. The penalty is payable with a

Form 8038-T for each 6-month period after

the date the bonds are issued. Do not make

any payment of penalty in lieu of rebate with

Form 8038-GC. See Rev. Proc. 92-22,

1992-1 C.B. 736, for rules regarding the

“election document.”

Line 12. Enter the name of the vendor or bank

who is a party to the installment purchase

agreement, loan, or financial lease. If there

are multiple vendors or banks, the issuer

should attach a schedule.

Line 13. Enter the employer identification

number of the vendor or bank who is a party

to the installment purchase agreement, loan,

or financial lease. If there are multiple vendors

or banks, the issuer should attach a schedule.

Signature and Consent

An authorized representative of the issuer

must sign Form 8038-GC and any applicable

certification. Also print the name and title of

the person signing Form 8038-GC. The

authorized representative of the issuer signing

this form must have the authority to consent

to the disclosure of the issuer's return

information, as necessary to process this

return, to the person(s) that has been

designated in this form.

Note. If the issuer authorizes in line 6 the IRS

to communicate with a person other than an

officer or other employee of the issuer, (such

authorization shall include contact both in

writing regardless of the address entered in

lines 3 and 4, and by telephone) by signing

this form, the issuer's authorized

representative consents to the disclosure of

the issuer's return information, as necessary

to process this return, to such person.

Paid Preparer

If an authorized representative of the issuer

filled in its return, the paid preparer’s space

should remain blank. Anyone who prepares

the return but does not charge the

organization should not sign the return.

Certain others who prepare the return should

not sign. For example, a regular, full-time

employee of the issuer, such as a clerk,

secretary, etc., should not sign.

Generally, anyone who is paid to prepare a

return must sign it and fill in the other blanks

in the Paid Preparer Use Only area of the

return. A paid preparer cannot use a social

security number in the Paid Preparer Use Only

box. The paid preparer must use a preparer

tax identification number (PTIN). If the paid

preparer is self-employed, the preparer

should enter his or her address in the box.

The paid preparer must:

• Sign the return in the space provided for the

preparer’s signature, and

• Give a copy of the return to the issuer.

Paperwork Reduction Act Notice

We ask for the information on this form to

carry out the Internal Revenue laws of the

United States. You are required to give us the

information. We need it to ensure that you are

complying with these laws.

You are not required to provide the

information requested on a form that is

subject to the Paperwork Reduction Act

unless the form displays a valid OMB control

number. Books or records relating to a form

or its instructions must be retained as long as

their contents may become material in the

administration of any Internal Revenue law.

Generally, tax returns and return information

are confidential, as required by section 6103.

The time needed to complete and file this

form will vary depending on individual

circumstances. The estimated average time is:

Learning about the

law or the form . . . . 4 hr., 46 min.

Preparing the form . . . . 2 hr., 22 min.

Copying, assembling, and

sending the form to the IRS . 2 hr., 34 min.

If you have comments concerning the

accuracy of these time estimates or

suggestions for making this form simpler, we

would be happy to hear from you. You can

write to the Internal Revenue Service, Tax

Products Coordinating Committee,

SE:W:CAR:MP:T:M:S, 1111 Constitution Ave.

NW, IR-6526, Washington, DC 20224. Do not

send the form to this address. Instead, see

Where To File.

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