Information Return

for Private Activity Bond Issues
Under Section 103(1)
(Section references are to the Internal Revenue Code.)

rom 8038

Ganuary 1983)

Department of the Treasury
Internal Revenue Service

OMB No, 1545-0720
Expires 1-31-85

1 Issuer's name

2 Present address (including city, town or post office, State and ZIP code)

3 Issuer's employer
identification number

4 Date of issue

Type of Issue (Check box(es) that apply)

Private Activity Bonds other than Industrial Development Bonds (IDBs): SIC code Amount $ SIC code Amount $
5 [[] Student loan bond. . . :_ Gy ,GGGGGvvjitGjwjuju
6 [J Private exempt entity bond .

Industrial Development Bonds:

7 [ Industrial park bond . . So ee
8 ~ a [J $1 million small issue ‘DB
b [J $10 million small issue IDB sotto {
9 Exempt Activity Bond (check type(s) below):
a [J Residential rental projects (section 103(b)(4)(A)) .
b [J Sports facilities (section 103(b)(4)(B)) .
¢ [J Convention facilities (section 103(b)(4)(C)) .
d [J Airports, docks, etc., (section 103(b)(4)(D)) .
e [] Sewage or waste disposal facilities (section 103(b)(4)(E)) .
f [J Pollution control facilities (section 103(b)(4)(F)) .
g [J Water furnishing facilities (section 103(b)(4)(G)) .
h [1] Hydroelectric generating facilities (section 103(b)(4)(H)) .
i [J Mass commuting vehicles (section 103(b)(4)(1)) .
i [J Local district heating or cooling facilities (section 103(6)(4)()) . :
k_ © Facilities for the local furnishing of electric energy or gas (section 103(b)(4)(E)) .

BEG2THIE «Description of Obligations (See instructions)

10 @ (B) (0)

Maturity date Face amount

«c)
Stated interest rate

Term (in years)

%

%

%.

%.

%.

%

%

%

%.

%

%

%

%.

%.

%

%

%

%

%

%.

%

11 Weighted average maturity of the issue (in years) (complete only for IDBs) (see instructions) .

_>

For Paperwork Reduction Act Notice, see page 1 of the Instructions.

Form 8038 (1/83)


Form 8038 (1-83) Page 2
[2Tam lM Proceeds of Issue

12 Total purchase price (regs. section 1.103-13(d)(2)). 6 6 6 ee ee ee
13 Face amount of issue. ©. - ee 1 ee ee

14 Bond issuance costs. . . . oe hoe eee
15 Amounts allocated to reasonably required r reserve or ‘replacement fund (ees section 1. “103-14(4)) .

16 Lendable proceeds of the issue (see instructions) . wee wee eee

[Zlamkae Description of Financed Property (Do not complete for student loan bonds)

17 a Cost of 3-yr. ACRS property (or portion thereof financed by issue). . . .
b Cost of 5-yr. ACRS property (or portion thereof financed by issue) . .

¢ Cost of 10-yr. ACRS property (or portion thereof financed by issue). . . . . .
d Cost of 15-yr. ACRS property (or portion thereof financed by issue) .

e Cost of land (or portion thereof financed by issue). . . . . . 1 7.
f Cost of other property financed by the issue .

a
b

Proceeds used to refund prior issue. . . So ee
If issue is an advance refunding, enter the earliest call date . . > WWTH@C@Z€{?«»i'—TM|qwa

19 Average weighted economic life of the project (complete only for IDBs) . years.
ETA Description of Initial Principal Users (Do not complete for student loan bonds)

18

20 Initial Principal Users:

(A) (B) (c) «D)
User Name Address Employer identification
number

@

di)
iii)
(iv)
()

(vi)
(vii)

21 Common parents (if any) of initial principal users listed above:

@ 3) «© ©
User Name Address Employer identification
(from above) number

EEETGTE Approval of Issue (Complete only for IDBs)

22 Name of Governmental units approving issue D>...

23 Names and positions of applicable elected representatives or date of referenda approving issue

Under penalties of peru, declare that have examined this tun, ineuding aecompanying schedules and statements, and ty thebestof my knowledge and belief
Please it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Sign
Here >. >.

‘Signature of officer Date ‘Title
Date Check if
Paid Preparer’s > self-em-
y | signature ployed > []

Preparer’s 7

Firm's name (or Zip code
Use Only yours, if self-employed)

and addres

391-029-1 ‘3k US. GOVERNMENT PRINTING OFFICE : 1983—-O-391-029