Form 8038
(Rev. September 2018)
Department of the Treasury
Internal Revenue Service
Information Return for Tax-Exempt Private Activity Bond Issues
(Under Internal Revenue Code section 149(e))
See separate instructions.
Go to www.irs.gov/Form8038 for instructions and the latest information.
OMB No. 1545-0720
Part I Reporting Authority
Check if Amended Return
1 Issuer’s name 2 Issuer’s employer identification number
3a Name of person (other than issuer) with whom the IRS may communicate about this return (see instructions)
3b Telephone number of other person shown on 3a
4 Number and street (or P.O. box if mail is not delivered to street address) Room/suite
5 Report number (For IRS Use Only)
1
6 City, town, or post office, state, and ZIP code 7 Date of issue (MM/DD/YYYY)
8 Name of issue 9 CUSIP number
10a Name and title of officer or other employee of the issuer whom the IRS may call for more information
10b
Telephone number of officer or other employee shown on 10a
Part II Type of Issue (Enter the issue price.)
Issue Price
11 Exempt facility bond:
a Airport (sections 142(a)(1) and 142(c)) . . . . . . . . . . . . . . . . . . . . .
11a
b Docks and wharves (sections 142(a)(2) and 142(c)) . . . . . . . . . . . . . . . . 11b
c Water furnishing facilities (sections 142(a)(4) and 142(e)) . . . . . . . . . . . . . . 11c
d Sewage facilities (section 142(a)(5)) . . . . . . . . . . . . . . . . . . . . . 11d
e Solid waste disposal facilities (section 142(a)(6)) . . . . . . . . . . . . . . . . . 11e
f Qualified residential rental projects (sections 142(a)(7) and 142(d)) (see instructions) . . . . . 11f
Meeting 20–50 test (section 142(d)(1)(A)) . . . . . . . . . . . .
Meeting 40–60 test (section 142(d)(1)(B)) . . . . . . . . . . . .
Meeting 25–60 test (NYC only) (section 142(d)(6)) . . . . . . . . . .
Has an election been made for deep rent skewing (section 142(d)(4)(B))? . . Yes No
g Facilities for the local furnishing of electric energy or gas (sections 142(a)(8) and 142(f)) . . . . 11g
h Facilities allowed under a transitional rule of the Tax Reform Act of 1986 (see instructions) . . . 11h
Facility type
1986 Act section
i Qualified enterprise zone facility bonds (section 1394) (see instructions) . . . . . . . . . 11i
j Qualified empowerment zone facility bonds (section 1394(f)) (see instructions) . . . . . . . 11j
k Other (see instructions) 11k
l Qualified public educational facility bonds (sections 142(a)(13) and 142(k)) . . . . . . . . 11l
m Mass commuting facilities (sections 142(a)(3) and 142(c)) . . . . . . . . . . . . . . 11m
n Qualified highway or surface freight transfer facilities (sections 142(a)(15) and 142(m)) . . . . . 11n
o
Other (see instructions)
p
Local district heating or cooling facilities (sections 142(a)(9) and 142(g))
11p
q Other (see instructions) 11q
12a Qualified mortgage bond (section 143(a)) . . . . . . . . . . . . . . . . . . . 12a
b
Other (see instructions) 12b
13 Qualified veterans’ mortgage bond (section 143(b)) (see instructions) . . . . . . . . .
13
Check the box if you elect to rebate arbitrage profits to the United States . . . . .
14 Qualified small issue bond (section 144(a)) (see instructions) . . . . . . . . . . . .
14
Check the box for $10 million small issue exemption . . . . . . . . . . . .
15 Qualified student loan bond (section 144(b)) . . . . . . . . . . . . . . . . . . 15
16 Qualified redevelopment bond (section 144(c)) . . . . . . . . . . . . . . . . . 16
17 Qualified hospital bond (section 145(c)) (attach schedule—see instructions) . . . . . . . . 17
18 Qualified 501(c)(3) nonhospital bond (section 145(b)) (attach schedule—see instructions) . . . . 18
Check box if 95% or more of net proceeds will be used only for capital expenditures .
19 Nongovernmental output property bond (treated as private activity bond) (section 141(d)) . . . 19
20a
Other (see instructions)
b
Reissuance (see instructions)
20b
c
Other. Describe (see instructions)
20c
For Paperwork Reduction Act Notice, see separate instructions.
Cat. No. 49973K
Form 8038 (Rev. 9-2018)
Form 8038 (Rev. 9-2018)
Page 2
Part III Description of Bonds (Complete for the entire issue for which this form is being filed.)
21
(a) Final maturity date (b) Issue price (c) Stated redemption
price at maturity
(d) Weighted
average maturity
(e) Yield
$ $
years
%
Part IV Uses of Proceeds of Issue (including underwriters’ discount)
Amount
22 Proceeds used for accrued interest . . . . . . . . . . . . . . . . . . . . .
22
23 Issue price of entire issue (enter amount from line 21, column (b)) . . . . . . . . . . . 23
24 Proceeds used for bond issuance costs (including underwriters’ discount)
24
25 Proceeds used for credit enhancement . . . . . . . . . . . . 25
26 Proceeds allocated to reasonably required reserve or replacement fund . 26
27 Proceeds used to refund prior tax-exempt bonds. Complete Part VI . . 27
28 Proceeds used to refund prior taxable bonds. Complete Parts V and VI . 28
29 Add lines 24 through 28 . . . . . . . . . . . . . . . . . . . . . . . . . 29
30 Nonrefunding proceeds (subtract line 29 from line 23, enter amount here, and complete Part V) .
30
Part V
Description of Property Financed
Caution: Do not complete for qualified student loan bonds, qualified mortgage bonds, or qualified veterans’ mortgage
bonds.
31 Type of Property Financed:
Amount
a Land . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
31a
b Buildings and structures . . . . . . . . . . . . . . . . . . . . . . . . . 31b
c Equipment with recovery period of more than 5 years . . . . . . . . . . . . . . . 31c
d Equipment with recovery period of 5 years or less . . . . . . . . . . . . . . . . 31d
e Other. Describe (see instructions) 31e
32 North American Industry Classification System (NAICS) of the projects financed.
NAICS Code Amount of nonrefunding proceeds
a
$
b
$
NAICS Code Amount of nonrefunding proceeds
c
$
d
$
Part VI Description of Refunded Bonds (Complete this part only for refunding bonds.)
33 Enter the remaining weighted average maturity of the tax-exempt bonds to be refunded . . . . .
years
34 Enter the remaining weighted average maturity of the taxable bonds to be refunded . . . . . .
years
35 Enter the last date on which the refunded tax-exempt bonds will be called (MM/DD/YYYY) . . . .
/
/
36 Enter the date(s) the refunded bonds were issued (MM/DD/YYYY) . . . . . . . . . . . .
/
/
Part VII Miscellaneous
37
Name of governmental unit(s) approving issue (see the instructions)
38 Check the box if you have designated any issue under section 265(b)(3)(B)(i)(III) . . . . . . . . . . . . . .
39 Check the box if you have elected to pay a penalty in lieu of arbitrage rebate . . . . . . . . . . . . . .
40 a Check the box if you have identified a hedge and enter the following information . . . . . . . . . . . . .
b Name of hedge provider
c
Type of hedge
d
Term of hedge
41 Check the box if the hedge is superintegrated . . . . . . . . . . . . . . . . . . . . . . . . .
42 a Enter the amount of gross proceeds invested or to be invested in a guaranteed investment contract (GIC)
b Enter the final maturity date of the GIC (MM/DD/YYYY) . . . . . . . . . . . . . . . . .
/
/
c
Enter the name of the GIC provider
43 Check the box if the issuer has established written procedures to ensure that all nonqualified bonds of this issue are
remediated in accordance with the requirements under the Code and Regulations (see instructions) . . . . . . .
44 Check the box if the issuer has established written procedures to monitor the requirements of section 148 . . . .
45a
Enter the amount of reimbursement if some portion of the proceeds was used to reimburse expenditures .
b Enter the date the official intent was adopted (MM/DD/YYYY) . . . . . . . . . . . . . .
/
/
46
Check the box if the issue is comprised of qualified redevelopment, qualified small issue, or exempt facilities bonds, and
provide name and EIN of the primary private user . . . . . . . . . . . . . . . . . . . . . . .
Name
EIN
Form 8038 (Rev. 9-2018)
Form 8038 (Rev. 9-2018)
Page 3
Part VIII Volume Caps
Amount
47 Amount of state volume cap allocated to the issuer. Attach copy of state certification . . . .
47
48 Amount of issue subject to the unified state volume cap . . . . . . . . . . . . . . 48
49 Amount of issue not subject to the unified state volume cap or other volume limitations: 49
a
Of bonds for governmentally owned solid waste facilities, airports, docks, wharves, environmental
enhancements of hydroelectric generating facilities, or high-speed intercity rail facilities . . . .
49a
b Under a carryforward election. Attach a copy of Form 8328 to this return . . . . . . . . . 49b
c
Under transitional rules of the Tax Reform Act of 1986. Enter Act section
49c
d
Under the exception for current refunding (section 146(i) and section 1313(a) of the Tax Reform Act of 1986)
49d
50a Amount of issue of qualified veterans’ mortgage bonds . . . . . . . . . . . . . . . 50a
b Enter the state limit on qualified veterans’ mortgage bonds . . . . . . . . . . . . . 50b
51a
Amount of section 1394(f) volume cap allocated to issuer. Attach copy of local government certification
51a
b
Name of empowerment zone
52
Amount of section 142(k)(5) volume cap allocated to issuer. Attach copy of state certification
52
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
Preparer’s PTIN
Firm’s name
Firm’s address
Firm’s EIN
Phone no.
Form
8038 (Rev. 9-2018)
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