Form 8038-TC (Rev. 11-2012)
Page 2
Description of Use of Proceeds for Qualified Purpose Expenditures (Continued)
10 Developing course materials and/or staff training expenditures . . . . . . . . . . . 10
11 Pay principal, interest, or premiums on qualified bonds . . . . . . . . . . . . . . 11
12 Refinance a qualified indebtedness . . . . . . . . . . . . . . . . . . . . 12
13
Other (describe)
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13
14 Total qualified purpose expenditures (Sum of lines 1a through 13) . . . . . . . . . .
14
15
Percentage of total proceeds to be used for qualified purpose expenditures (Divide line
14 in Part V by line 7 in Part IV, multiply result by 100) . . . . . . . . . . . .
15
.
%
16
If some portion of proceeds was used to reimburse issuer for amounts paid for a qualified
purpose, enter the amount of reimbursement . . . . . . . . . . . . . . . . .
16
17
If some portion of proceeds was to reimburse issuer for amounts paid for a qualified purpose,
enter the date the official intent was adopted (MM/DD/YYYY)
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/ /
17
Part VI
Allocation of National, State, Tribal, or Local Bond Limitation Amount
(Enter source and amount of allocation and attach copy of certificate)
Amount
1a Volume cap allocation amount . . . . . . . . . . . . . . . . . . . . . .
1a
Year of Allocation . . . . . Amount of Carryforward . . .
b National, check box . . . . . . .
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Local, check box . . . . .
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c State, check box . . . . . . . . . . . . . . . . . . . . . . .
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d Tribal, check box . . . . . . . . . . . . . . . . . . . . . . .
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2 If box 1c is checked, enter State abbreviation . . . . . . . . . . . . .
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Part VII Miscellaneous
1 Arbitrage questions:
a If there is a reserve or sinking fund that is expected to repay the issue at maturity, check box . . . . . . . . .
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b If 1a is checked and the reserve or sinking fund is funded in equal periodic installments, check box . . . . . . .
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c
If either the funding of the reserve or sinking fund is expected to result in an amount greater than the amount necessary
to repay the issue; or, if the yield on such fund is greater than the permitted sinking fund yield from line 6, Part III, check
box . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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d
If the issuer established written procedures to monitor the requirements of section 148 with respect to these bonds,
check box . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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2
If all federal, state, and local requirements governing conflicts of interest are satisfied with respect to this issue, check box . .
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3 If the entitlements to credits with respect to this bond issue are expected to be stripped, check box . . . . . . .
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4 If the issuer established written procedures to ensure that all nonqualified bonds at the end of the applicable period are
redeemed within 90 days, check box . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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5 Other: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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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.
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Signature of issuer's authorized representative
Date
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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
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Firm's address
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Firm's EIN
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Phone no.
Part VIII Consent to Disclosure of Certain Information From This Return
1
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, stated
redemption price at maturity, applicable credit rate, and maximum term, to assist in the proper reporting of interest, tax credits, or
other benefits under IRC section 6049 and Regulations thereunder . . . . . . . . . . . . .
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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 IRC section 6049.
Sign
Here
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Signature
Date
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Type or print name and title
Form 8038-TC (Rev. 11-2012)