Information Return for Small Tax-Exempt

Governmental Bond Issues, Leases, and Installment Sales

Form 8038-GC

OMB No. 1545-0720 © Under Internal Revenue Code section 149(e)

Department of the Treasury

Internal Revenue Service Caution: If the issue price of the issue is $100,000 or more, use Form 8038-G.

Reporting Authority Check box if Amended Return ©

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

3 Number and street (or P.O. box if mail is not delivered to street address)

4 City, town, or post office, state, and ZIP code

Description of Obligations Check one: a single issue or a consolidated return .

8a Issue price of obligation(s) (see instructions) 8a

b

9 Amount of the reported obligation(s) on line 8a that is:

a For leases for vehicles 9a

b For leases for office equipment 9b

Who Must File

General Instructions

Section references are to the Internal Revenue Code

unless otherwise noted.

Part I

Part II

Room/suite

(Rev. May 2009)

10 If the issuer has designated any issue under section 265(b)(3)(B)(i)(III) (small issuer exception), check this box ©

Purpose of Form

Form 8038-GC is used by the issuers of tax-exempt

governmental obligations to provide the IRS with the

information required by section 149(e) and to monitor

the requirements of sections 141 through 150.

Issuers of tax-exempt governmental obligations with

issue prices of less than $100,000 must file Form

8038-GC.

Issuers of a tax-exempt governmental obligation

with an issue price of $100,000 or more must file

Form 8038-G, Information Return for Tax-Exempt

Governmental Obligations.

Filing a separate return for a single issue. Issuers

have the option to file a separate Form 8038-GC for

any tax-exempt governmental obligation with an

issue price of less than $100,000.

Filing a consolidated return for multiple issues.

For all tax-exempt governmental obligations with

issue prices of less than $100,000 that are not

reported on a separate Form 8038-GC, an issuer

must file a consolidated information return including

all such issues issued within the calendar year.

Thus, an issuer may file a separate Form 8038-GC

for each of a number of small issues and report the

remainder of small issues issued during the calendar

year on one consolidated Form 8038-GC. However,

a separate Form 8038-GC must be filed to give the

IRS notice of the election to pay a penalty in lieu of

arbitrage rebate.

When To File

To file a separate return for a single issue, file Form

8038-GC on or before the 15th day of the second

calendar month after the close of the calendar

quarter in which the issue is issued.

To file a consolidated return for multiple issues, 

file Form 8038-GC on or before February 15th of the

calendar year following the year in which the issue is

issued.

6 Name and title of officer or legal representative whom the IRS may call for more information

5 Report number (For IRS Use Only)

7 Telephone number of officer or legal representative

5

( )

Issue date (single issue) or calendar date (consolidated). Enter date in mm/dd/yyyy format

(for example, 01/01/2009) (see instructions) ©

11

12

If the issuer has elected to pay a penalty in lieu of arbitrage rebate, check this box (see instructions) ©

Vendor’s or bank’s name:

c For leases for real property 9c

d For leases for other (see instructions) 9d

e For bank loans for vehicles 9e

9f f For bank loans for office equipment

9g g For bank loans for real property

h For bank loans for other (see instructions) 9h

9i i Used to refund prior issue(s)

9j j Representing a loan from the proceeds of another tax-exempt obligation (for example, bond bank)

k Other 9k

13 Vendor’s or bank’s employer identification number:

Where To File

File Form 8038-GC, and any attachments, with the

Department of the Treasury, Internal Revenue Service

Center, Ogden, UT 84201.

Proc. 2002-48, 2002-2 C.B. 531, if it is determined

that the failure to file on time is not due to willful

neglect. Type or print at the top of the form,“Request

for Relief under Section 3 of Rev. Proc. 2002-48.” 

Attach to the Form 8038-GC a letter briefly stating

why the form was not submitted to the IRS on time.

Also indicate whether the obligation in question is

under examination by the IRS. Do not submit copies

of any bond documents, leases, or installment sale

documents. See Where To File below.

An issuer of a tax-exempt bond used to finance

construction expenditures must file a separate Form

8038-GC for each issue to give notice to the IRS that Late filing. An issuer may be granted an extension of

time to file Form 8038-GC under Section 3 of Rev.

Form 8038-GC Receipt

Acknowledgement

If you wish to request an acknowledgement receipt of

this return by the IRS you must provide the following:

Other Forms That May Be Required

For rebating arbitrage (or paying a penalty in lieu of

arbitrage rebate) to the Federal Government, use

Form 8038-T, Arbitrage Rebate, Yield Reduction and

Penalty in Lieu of Arbitrage Rebate. For private

activity bonds, use Form 8038, Information Return for

Tax-Exempt Private Activity Bond Issues.

/ /

Sign

Here

Date Preparer’s SSN or PTIN Preparer’s

signature

Check if

self-employed

Paid

Preparer’s 

Use Only

Firm’s name (or

yours if self-employed),

address, and ZIP code

EIN

Phone no. ( )

©

©

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.

Issuer’s authorized representative Date Type or print name and title

© ©

an election was made to pay a penalty in lieu of

arbitrage rebate (see the line 11 instructions).
Form 8038-GC (Rev. 5-2009) Page 2

Specific Instructions

Part I—Reporting Authority

Line 1. The issuer’s name is the name of the entity

issuing the obligations, not the name of the entity

receiving the benefit of the financing. In the case of a

lease or installment sale, the issuer is the lessee or

purchaser.

Line 2. An issuer that does not have an employer

identification number (EIN) should apply for one on

Form SS-4, Application for Employer Identification

Number. You can get this form on the IRS website at

www.irs.gov or by calling 1-800-TAX-FORM

(1-800-829-3676). You may receive an EIN by

telephone by following the instructions for Form SS-4.

Part II—Description of Obligations

Arbitrage rebate. Generally, interest on a state or

local bond is not tax-exempt unless the issuer of the

bond rebates to the United States arbitrage profits

earned from investing proceeds of the bond in higher

yielding nonpurpose investments. See section 148(f).

Construction issue. This is an issue of tax-exempt

bonds that meets both of the following conditions:

Line 11. Check this box if the issue is a construction

issue and an irrevocable election to pay a penalty in

lieu of arbitrage rebate has been made on or before

the date the bonds were issued. The penalty is

payable with a Form 8038-T for each 6-month period

after the date the bonds are issued. Do not make

any payment of penalty in lieu of rebate with Form

8038-GC. See Rev. Proc. 92-22, 1992-1 C.B. 736,

for rules regarding the “election document.”

In general, a Form 8038-GC must be completed on

the basis of available information and reasonable

expectations as of the date of issue. However, forms

that are filed on a consolidated basis may be

completed on the basis of information readily

available to the issuer at the close of the calendar

year to which the form relates, supplemented by

estimates made in good faith.

If you have comments concerning the accuracy of

these time estimates or suggestions for making this

form simpler, we would be happy to hear from you.

You can write to the Internal Revenue Service, Tax

Products Coordinating Committee,

SE:W:CAR:MP:T:T:SP, 1111 Constitution Ave. NW,

IR-6526, Washington, DC 20224. Do not send the form

to this address. Instead, see Where To File on page 1.

Paperwork Reduction Act Notice

We ask for the information on this form to carry out

the Internal Revenue laws of the United States. You

are required to give us the information. We need it to

ensure that you are complying with these laws.

The time needed to complete and file this form will

vary depending on individual circumstances. The

estimated average time is:

Learning about the

law or the form 4 hr., 46 min.

Preparing the form 2 hr., 22 min.

Copying, assembling, and

sending the form to the IRS 2 hr., 34 min.

You are not required to provide the information

requested on a form that is subject to the Paperwork

Reduction Act unless the form displays a valid OMB

control number. Books or records relating to a form

or its instructions must be retained as long as their

contents may become material in the administration

of any Internal Revenue law. Generally, tax returns

and return information are confidential, as required

by section 6103.

1. At least 75% of the available construction

proceeds of the issue are to be used for construction

expenditures with respect to property to be owned by

a governmental unit or a 501(c)(3) organization, and

Line 5. This line is for IRS use only. Do not make

any entries in this box.

Line 8a. The issue price of obligations is generally

determined under Regulations section 1.148-1(b).

Thus, when issued for cash, the issue price is the

price at which a substantial amount of the obligations

are sold to the public. To determine the issue price of

an obligation issued for property, see sections 1273

and 1274 and the related regulations.

Line 8b. For a single issue, enter the date of issue

(for example, 03/15/2008 for a single issue issued on

March 15, 2008), generally the date on which the

issuer physically exchanges the bonds that are part

of the issue for the underwriter’s (or other

purchaser’s) funds; for a lease or installment sale,

enter the date interest starts to accrue. For issues

reported on a consolidated basis, enter the first day

of the calendar year during which the obligations

were issued (for example, for calendar year 2008,

enter 01/01/2008).

apply to a particular obligation. For example, report

on lines 9i and 9j obligations used to refund prior

issues which represent loans from the proceeds of

another tax-exempt obligation.

● More than 10% of the payment of principal or

interest of the issue is either (a) secured by an

interest in property to be used for a private business

use (or payments for such property) or (b) to be

derived from payments for property (or borrowed

money) used for a private business use.

It also includes a bond, the proceeds of which (a)

are to be used to make or finance loans (other than

loans described in section 141(c)(2)) to persons other

than governmental units and (b) exceeds the lesser 

of 5% of the proceeds or $5 million.

Issue. Generally, obligations are treated as part of

the same issue only if they are issued by the same

issuer, on the same date, and as part of a single

transaction, or a series of related transactions.

However, obligations issued during the same

calendar year (a) under a loan agreement under

which amounts are to be advanced periodically (a

“draw-down loan”) or (b) with a term not exceeding

270 days, may be treated as part of the same issue if

the obligations are equally and ratably secured

under a single indenture or loan agreement and are

issued under a common financing arrangement (for

example, under the same official statement

periodically updated to reflect changing factual

circumstances). Also, for obligations issued under a

draw-down loan that meets the requirements of the

preceding sentence, obligations issued during

different calendar years may be treated as part of

the same issue if all of the amounts to be advanced

under the draw-down loan are reasonably expected

to be advanced within 3 years of the date of issue of

the first obligation. Likewise, obligations (other than

private activity bonds) issued under a single

agreement that is in the form of a lease or

installment sale may be treated as part of the same

issue if all of the property covered by that agreement

is reasonably expected to be delivered within 3 years

of the date of issue of the first obligation.

Definitions

Obligations. This refers to a single tax-exempt

governmental obligation if Form 8038-GC is used for

separate reporting or to multiple tax-exempt

governmental obligations if the form is used for

consolidated reporting.

Tax-exempt obligation. This is a bond, installment

purchase agreement, or financial lease, on which the

interest is excluded from income under section 103.

Private activity bond. This includes an obligation

issued as part of an issue in which:

● More than 10% of the proceeds are to be used for

any private activity business use, and

Lines 3 and 4. Enter the issuer’s address. If the

issuer receives its mail in care of a third party

authorized representative (such as an accountant or

attorney), enter on the street address line “C/O” 

followed by the third party’s name and street

address or P.O. box. Include the suite, room, or other 

unit number after the street address. If the post office

does not deliver mail to the street address and the

issuer has a P.O. box, show the box number instead

of the street address. If a change in address occurs

after the return is filed, use Form 8822, Change of

Address, to notify the IRS of the new address.

Check the appropriate box designating this as a

return on a single issue basis or a consolidated return

basis.

Line 9k. Enter on line 9k the amount on line 8a that

does not represent an obligation described on lines

9a through 9j.

Line 10. Check this box if the issuer has designated

any issue as a “small issuer exception” under

section 265(b)(3)(B)(i)(III).

Line 12. Enter the name of the vendor or bank who

is a party to the installment purchase agreement,

loan, or financial lease. If there are multiple issuers or

banks, issuers should attach a schedule.

Line 13. Enter the employer identification number of

the vendor or bank who is a party to the installment

purchase agreement, loan, or financial lease. If there

are multiple issuers or banks, issuers should attach a

schedule.

An authorized representative of the issuer must sign

Form 8038-GC and any applicable certification. Also

print the name and title of the person signing Form

8038-GC.

Signature

Rounding to Whole Dollars

You may show the money items on this return as

whole-dollar amounts. To do so, drop any amount

less than 50 cents and increase any amount from 50

to 99 cents to the next higher dollar.

● A copy (or copies, if multiple acknowledgements

are requested) of the return being filed, with

“Acknowledgement Copy” written across the top of

the first page of each copy. For multiple requests,

the copies must be stapled together.

● A cover letter specifically requesting the

acknowledgement of this return.

● A self-addressed stamped envelope for each

acknowledgement receipt recipient.

2. All of the bonds that are part of the issue are

qualified 501(c)(3) bonds, bonds that are not private

activity bonds, or private activity bonds issued to

finance property to be owned by a governmental unit

or a 501(c)(3) organization.

Amended return. An issuer may file an amended

return to change or add to the information reported

on a previously filed return for the same date of

issue. If you are filing to correct errors or change a

previously filed return, check the “Amended Return” 

box in the heading of the form.

The amended return must provide all the

information reported on the original return, in

addition to the new corrected information. Attach an

explanation of the reason for the amended return.

Lines 9a through 9h. Complete this section if property

other than cash is exchanged for the obligation, for

example, acquiring a police car, a fire truck, or

telephone equipment through a series of monthly

payments. (This type of obligation is sometimes

referred to as a “municipal lease.”) Also complete this

section if real property is directly acquired in exchange

for an obligation to make periodic payments of interest

and principal. For lines 9a through 9d, enter the

amount on the appropriate line that represents a lease

or installment purchase. For line 9d, enter the type of

item that is leased. For lines 9e through 9h, enter the

amount on the appropriate line that represents a bank

loan. For line 9h, enter the type of bank loan.

In lieu of rebating any arbitrage that may be owed to the

United States, the issuer of a construction issue may

make an irrevocable election to pay a penalty. The penalty

is equal to 11⁄2 % of the amount of construction proceeds

that do not meet certain spending requirements. See

section 148(f)(4)(C) and the Instructions for Form 8038-T.

Generally, anyone who is paid to prepare a return

must sign it and fill in the other blanks in the Paid

Preparer’s Use Only area of the return.

● Sign the return in the space provided for the

preparer’s signature,

● Enter the preparer information, and

● Give a copy of the return to the issuer.

Paid Preparer

The paid preparer must:

If an authorized representative of the issuer filled in

its return, the paid preparer’s space should remain

blank. Anyone who prepares the return but does not

charge the organization should not sign the return.

Certain others who prepare the return should not

sign. For example, a regular, full-time employee of

the issuer, such as a clerk, secretary, etc., should

not sign.

Lines 9i and 9j. For line 9i, enter the amount of the

proceeds that will be used to pay principal, interest,

or call premium on any other issue of bonds,

including proceeds that will be used to fund an

escrow account for this purpose. Several lines may