Request for Recovery of Overpayments

Under Arbitrage Rebate Provisions

Form 8038-R

OMB No. 1545-1750

Department of the Treasury

Internal Revenue Service See instructions on back.

Reporting Authority

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 Report number

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

7 Name of issue 8 CUSIP number

Request for Refund of Amounts Paid Under Rebate Provisions (see instructions)

12 Total amount paid under rebate provisions

19

20

16

18

21

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20

Other Information (see instructions)

For Paperwork Reduction Act Notice, see back of form. Form 8038-R (Rev. 1-2006)

Part III

Part I

Part II

Cat. No. 57334H

(Rev. January 2006)

Room/suite

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

( )

21

Rebate amount as of the most recent computation date

Amounts (not included in line 12) required to be paid under section

148 as of the date the recovery is requested

Add lines 13 and 14

Amount of overpayment. Subtract line 15 from line 12

Schedule of payments (see instructions). Attach additional sheets if necessary.

Was the overpayment paid as penalty in lieu of rebate under section 148(f)(4)(C)(vii)? 

Has the final computation date for the issue occurred? 

Is the issue comprised of qualified redevelopment, qualified small issue, or exempt facilities bonds? If “Yes,”

provide name and EIN of the primary private user.

Check the “Yes” or “No” box for each question below. Yes No

Under penalties of perjury, I declare that I have examined this request for recovery of overpayment, including accompanying schedules and

statements, and to the best of my knowledge and belief, the facts represented in support of the request are true, correct, and complete.

Sign

Here Signature of issuer’s authorized representative Date Type or print name and title 

13

14

15

File a separate form for each issue.

11 If the issue is outstanding on June 30, 1993, and the issuer elects not to apply the 1992 regulations, check here (see

instructions) 

17 Computations and relevant facts that led to overpayment (see instructions). Attach additional sheets if necessary.

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15

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Name EIN General Instructions

Section references are to the Internal Revenue Code unless

otherwise noted.

Note. Use a separate Form 8038-R for each issue.

Purpose of Form

Form 8038-R is used by issuers of state and local bonds to request

a refund of amounts paid with Form 8038-T.

Payments made with Form 8038-T that may be recoverable

include:

1. Yield reduction payments,

2. The arbitrage rebate to the United States,

3. A penalty in lieu of rebating arbitrage to the United States, or

4. A penalty to terminate the election to pay a penalty in lieu of

rebating arbitrage.

Recovery of Overpayment

In general, an issuer may recover an overpayment of rebate for an

issue of tax-exempt bonds by establishing to the Internal Revenue

Service that the overpayment occurred. An overpayment is the

excess of the amount paid to the United States for an issue under

section 148 over the sum of the rebate amount for the issue as of

the most recent computation date and all amounts that are

otherwise required to be paid under section 148 as of the date the

recovery is requested.

An overpayment may be recovered only to the extent that a

recovery on the date that it is first requested would not result in an

additional rebate amount if that date were treated as a computation

date.

Except for overpayments of penalty in lieu of rebate under section

148(f)(4)(C)(vii) and Regulations section 1.148-7(k), an overpayment of

less than $5,000 may not be recovered before the final computation

date. See Regulations section 1.148-3(i).

Processing the Request

Generally, this information will be sufficient to determine whether a

refund is appropriate. However, if additional information is necessary,

the IRS will contact the issuer or its representative. Processing of the

request will then be suspended and the issuer will have 30 calendar

days to submit the requested information. If all the requested

information is not timely received, a letter will be sent explaining that

the request for recovery is deficient and that its processing is

terminated. This letter may also be sent instead of a request for

additional information if the initial request for recovery is severely

deficient.

Any proposed adverse determination may be appealed. See Rev.

Proc. 99-35, 1999-2 C.B. 501, for details.

Where To File

File Form 8038-R, and attachments, with the Internal Revenue

Service, Ogden Submission Processing Center, Ogden, UT 84201.

Signature

Form 8038-R must be signed by an authorized representative of the

issuer. Also type or print the name and title of the person signing

Form 8038-R.

Specific Instructions

Part I. Reporting Authority

Line 1. Enter the name of the governmental entity that issued the

bonds, not the name of the entity receiving the benefit of the

financing.

Line 6. Enter the date of issue. This is generally the first date on

which there is a physical exchange of the bonds for the purchase

price.

Line 7. Enter the name of the issue. If there is no name, please

provide other identification of the issue.

Line 8. Enter the CUSIP (Committee on Uniform Securities

Identification Procedures) number of the bond with the latest

maturity. Enter “None” if the issue does not have a CUSIP number.

Part II. Request for Refund

Line 17. Provide the computations of the overpayment paid as part

of a rebate payment, penalty in lieu of rebate, or to terminate the

penalty in lieu of rebate. Also, include the computations for interest

(if any). If relevant, a description of the facts that led to the

overpayment may also be included.

Line 18. Provide a schedule showing amounts and dates that

payments were made to the United States for the issue. Attach

copies of Form(s) 8038-T that accompanied payments to the United

States.

Part III. Other Information

Line 20. The final computation date is the date the issue is

discharged. For details, see Regulations section 1.148-3(e)(2).

Line 21. Check the “Yes” box if:

The issue is comprised of... As described in section...

Qualified redevelopment bonds 144(c)

Qualified small issue bonds 144(a)

Exempt facilities bonds 142(a)(4) through 142(a)(11)

and 142(a)(13) through 142(a)(15)

If one of the above applies, then enter the name and employer

identification number (EIN) of the primary private user. A “private

user” is the nongovernmental entity that meets the private business

tests of section 141(b) or private loan financing test of section 141(c).

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.

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.

The time needed to complete and file this form will vary depending

on individual circumstances. The estimated average time is:

Recordkeeping, 5 hr., 44 min.; Learning about the law or the

form, 3 hr., 10 min.; Preparing, copying, assembling, and sending

the form to the IRS, 3 hr., 24 min.

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-6406,

Washington, DC 20224. Do not send the form to this address.

Instead, see Where To File above.

Form 8038-R (Rev. 1-2006) Page 2

Line 11. Current Regulations sections 1.148-1 through 1.148-11

apply to issues outstanding after June 30, 1993. If the issue was

outstanding prior to July 1, 1993, the 1992 regulations apply (that is,

Regulations sections 1.148-1 through 1.148-12 effective May 18,

1992 (T.D. 8418, 1992-1 C.B. 29)). However, check the box if the

issue was outstanding prior to July 1, 1993, and the issuer has

elected not to apply the 1992 regulations; the current Regulations

sections 1.148-1 through 1.148-11 apply.

What’s New

You must attach all copies of Form 8038-T, Arbitrage Rebate, Yield

Reduction, and Penalty in Lieu of Arbitrage Rebate, which are related

to the request for refund.

When filing Form 8038-R, you must provide:

● All copies of Form(s) 8038-T related to the request for refund, and

● The computations of the overpayment and interest (if any) on 

line 17. Provide any additional attachments if needed.