Form 8038-T Arbitrage Rebate and

(Rev. January 2002) Penalty in Lieu of Arbitrage Rebate OMB No. 1545-1219

 Under Sections 143(g)(3) and 148(f)

and Sections 103(c)(6)(D) and 103A(i)(4) of the Internal Revenue Code of 1954 Department of the Treasury

Internal Revenue Service

Reporting Authority

1 Issuer’s name 2 Issuer’s employer identification number

3 Number and street (or P.O. box no. if mail is not delivered to street address) 4 Report number

5 City, town, or post office, state, and ZIP code 6 Date of issue

7 Name of issue 8 CUSIP number

Yield Reduction, Arbitrage Rebate, and Penalty in Lieu of Arbitrage Rebate

Type of issue  Issue price 

If Form 8038, Form 8038-G, or Form 8038-GC was not filed, check here 

$

14

Amount of yield reduction payment (see instructions)

15

Amount of rebate paid for the period (MMDDYYYY) from  to 

$

17

Interest on underpayment of arbitrage rebate (see instructions)

Elections by the Issuer Check “Yes” or “No” for each question (see instructions) Yes No

Treat the last day of the bond year on a variable yield issue as the computation date?

Treat a transitioned variable yield issue as a fixed yield issue?

Apply the rules under section 148 to determine if the bond complies with section 103(c)(6)(D) of the 1954 Code?

Treat a variable yield bond that is not a tender bond as a fixed yield bond after it converted to a fixed rate?

Continue treating an issue as a variable yield issue after all the bonds in the issue converted to a fixed rate?

27

Recompute the yield on a transitioned fixed yield issue?

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.

Sign

Here

Signature of officer Type or print name and title Date

Form 8038-T (Rev. 1-2002)

Part I

Part II



Cat. No. 11545Y

Room/suite

11

Date of most recently filed Form 8038-T for this issue (MMDDYYYY)

12

Is this the final Form 8038-T for this issue? 

Part III

18

Number of months since date of issue, check the box:

19

Available construction proceeds  $ Unspent  $

If you elected to terminate the election to pay the penalty in lieu of arbitrage rebate, check one of the following

(see instructions): A B

21

Penalty in lieu of rebate

22

Amount of arbitrage rebate previously paid for this issue

13

28

29

30

31

32

33

Identify a hedge?

Use an actual facts analysis?

Exclude earnings on a reasonably required reserve or replacement fund from available construction proceeds?

Treat the different purposes of a multipurpose issue as separate issues for purposes of the 2-year exception?

Treat each loan of a pooled financing issue as a separate issue for purposes of applying the spending exception?

6 mos 12 mos 18 mos 24 mos Other. No. of mos 

A. Elections made under the 1992 regulations. Did you elect to:

B. Elections made under the 1993 regulations. Did you elect to:

Yes No

$

35

Apply certain provisions of section 1.148-11A(i) before the effective date?

34



Apply certain provisions of section 1.148-11(b) before the effective date?

28

29

30

31

32

33

34

35

36

37

39

38

For Paperwork Reduction Act Notice, see the separate instructions.

Check box if Amended Return 

9 Name and title of officer or legal representative whom the IRS may call for more information 10 Telephone number of officer or legal representative

( )

$

$

16

Penalty for failure to pay arbitrage rebate on time (attach statement)

20

23

36

37

38

39

7

$

Yield Reduction

Arbitrage Rebate

Penalty in Lieu of Arbitrage Rebate

Date of termination (MMDDYYYY)

24 Penalty upon termination

25 Penalty for failure to pay on time (attach statement)

26 Interest on underpayment of penalty in lieu of rebate or upon termination (see instructions)

Total payment. Add lines 16, 17, 18, 19, 23, 24, 25, and 26. Enter total here 

$

$

$

$

$

17

27

11

12

18

19

16

23

24

25

26

40 40