Form 8038

(Rev. April 2011)

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. 

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 District of Columbia Enterprise Zone facility bonds (section 1400A) . . . . . . . . . . . 11k

l Qualified public educational facility bonds (sections 142(a)(13) and 142(k)) . . . . . . . . 11l

m Qualified green building and sustainable design projects (sections 142(a)(14) and 142(l)) . . . . 11m

n Qualified highway or surface freight transfer facilities (sections 142(a)(15) and 142(m)) . . . . . 11n

o Other (see instructions)

p Qualified New York Liberty Zone bonds (section 1400L(d)) 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 New York Liberty Zone advance refunding bond (section 1400L(e)) (see instructions) 20b

c Other. Describe (see instructions) ▶ 20c

For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 49973K Form 8038 (Rev. 4-2011) 
Form 8038 (Rev. 4-2011) 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 currently refund prior issue (complete Part VI) . . . . 27 

28 Proceeds used to advance refund prior issue (complete Part VI) . . . . 28 

29 Add lines 24 through 28 . . . . . . . . . . . . . . . . . . . . . . . . . 29 

30 Nonrefunding proceeds of the issue (subtract line 29 from line 23 and enter amount here) . . . 30 

Part V Description of Property Financed by Nonrefunding Proceeds 

Caution: The total of lines 31a through e below must equal line 30 above. Do not complete for qualified student loan

bonds, qualified mortgage bonds, or qualified veterans’ mortgage bonds.

31 Type of Property Financed by Nonrefunding Proceeds: 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 by nonrefunding proceeds.

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 bonds to be currently refunded . . . . . . ▶ years

34 Enter the remaining weighted average maturity of the bonds to be advance refunded . . . . . . ▶ years

35 Enter the last date on which the refunded bonds will be called . . . . . . . . . . . . . ▶ / /

36 Enter the date(s) the refunded bonds were issued ▶

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 . . . . . . . . . . . . . . . . . . . . . . ▶ / /

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 . . . . . . . . . . . . . . . . . . . . ▶ / /

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. 4-2011) 
Form 8038 (Rev. 4-2011) 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. 4-2011)