rom 8038 Information Return for Tax-Exempt

(Rev. December 1986) Private Activity Bond Issues OMB No. 1545:0720
Department of the Treasury > Under Section 149(e) Expires 12/31/89
Internal Revenue Service
Reporting Authority Check box if Amended Return > [_]
1 Issuer's name 2 Issuer's employer identification number
3 Number and street 4 Report number

PA198 __-
5 City or town, state, and ZiP code 6 Date of issue
| Part 11] Type of Issue (check box(es) that applies) Issue Price

7 © Qualified hospital bond (section 145(c)) . a
s Qualified section 501(c)(3) bond other than a qualified hospital bond (ection 145)
9 J Qualified student loan bond (section 144(b)) . .
10 O Qualified mortgage bond (section 143(a)). Check box if you elect to rebate arbitrage profits
tothe U.S. >
no Qualified veterans’ mortgage bond ection 143(b)). Check box if you elect to rebate arbitrage profits
tothe U.S. >
12 | Qualified redevelopment bond (section aac - a
13 Qualified small issue bond (section 144(a)). Check box for $10 million ‘small issue exemption >
14 Exempt facility bond: YY
a CJ Airport (section 142(a)(1)) . fe
b LJ Docks and wharves (section 142(a)(2))
¢ CI Mass commuting facilities (section 142(a)(3))
d CI Water furnishing facilities (section 142(a)(4))
CO sewage facilities (section 142(a)(5)) :
I Solid waste disposal facilities (section 142(a)(6))
CT Residential rental projects (section 142(a)(7)) .
CI Facilities for the local furnishing of electric energy or gas (section 142(a(8))
C1 Local district heating or cooling facilities (section 142(a)(9)) .
ju Qualified hazardous waste facilities (section 142(a)(10)) .
oO Sports facilities (see instructions) Soe ee
CO Convention or trade show facilities (see instructions) soe ee
CJ Pollution contro! facilities (see instructions)
oO Hydroelectric generating facilities (see instructions)
Parking facilities (see instructions) . . . 6.) 1 ee
1 Industrial parks (see instructions) 2. 6 6 ee ee ee
16 (J other. Describe (see instructions) >

igtaaily Description of Bonds

@ © stated revempt weighted © Inottterest
Maturity date Interest rate Issue price price at maturity. eeraturity | ied [erent
17° ‘Final maturity. . %
18 Entireissue__._. years|

Faia Uses of Original Proceeds of Issue (including underwriters’ discount)

19 Proceeds used foraccruedinterest . . . . Se ee ee LD
20 Proceeds used for bond issuance costs (including underwriters’ discount) . wo ee ee ee £20
21 Proceeds used forcreditenhancement. . . . . ee ee ee PRE
22 Proceeds allocated to reasonably required reserve or replacement fund re a
23 Proceeds used to refund prior issues (complete Part VI). 2. . 123
24 __Nonrefunding proceeds of the issue (subtract lines 20, 21, 22, and 23 from line 18, column (Oy) o | 24

For Paperwork Reduction Act Notice, see page 1 of the Instructions. Form 8038 (Rev. 12-86)


Form 8038 (Rev. 12-86) Page 2
Description of Property Financed by Nonrefunding Proceeds
(Do not complete for qualified student loan bonds, qualified mortgage bonds, or qualified veterans’ mortgage bonds.)

25 Type of Property Financed by Nonrefunding Proceeds |___ Amount

a Land. . eo ee ee ee .

b Buildings and structures .

c Equipment with an ACRS life of more ‘than 5 years

d_ Equipment with an ACRS life of 5 years or less _
26 Standard industrial classification (SIC) of nonrefunding proceeds ‘for the financed projects.
SIC Code Nonrefunding proceeds $ SIC Code Nonrefunding proceeds $
a c
b d

Description of Refunded Bonds (complete this part only for refunding bonds)

27 Enter the remaining weighted average maturity of the bondstoberefunded. . . . - . . - - ws « BTS
28 Enter the last date on which the refunded bonds willbecalled . . © 2 1. 1 ee ee eee
29 Enter the date(s) the refunded bonds were issued >

Miscellaneous

30 Name of governmental unit(s) approving issue >

31 = Arbitrage rebate:

a Check box if the 6-month temporary investment exception to the arbitrage rebate requirement is oxpected toaply ....» CI
b Check box if you expect to earn and rebate arbitrage profitstothe U.S. . woe sone |
32 Enter the amount of the bonds designated by the issuer under section 265(b3\(B).ii)_ ee

ielaadiig Volume Cap

33 Check box if qualified veterans’ mortgage bonds. > (Enter the amount of the state veterans’ limit >
34 Check box if any part of the issue is subject to the unified state volume cap » LI Amount
35 Amount of volume cap allocated to the issue. You must attach state certification .
36 Amount of issue excepted from the volume cap:

Under a carryforward election. Enter the date oftheelection. . . rn
As governmentally owned solid waste facilities, airports, docks, or wharves

As qualified section 501(c)(3) bonds .

Under the exception for current refundings .

Under transition rules for the Tax Reform Act of 1986. Enter the Act section(s) of the transition rule(s)

eanocse

Under penalties of perjury, | declare that | have examined this return, and accompanying schedules and statements, and to the best of my knowledge and belief
Please they are true, correct, and complete.

Sign
Here » Signature of officer Date » Title

SFU.S, Government Printing Office: 1987—201-993/60161