Information Return for Tax-Exempt Governmental Obligations Form 8038-G

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

(Rev. November 2000)  See separate Instructions.

Department of the Treasury

Internal Revenue Service Caution: If the issue price is under $100,000, use Form 8038-GC.

Reporting Authority If Amended Return, check here 

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

3

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

7 Name of issue 8 CUSIP number

Type of Issue (check applicable box(es) and enter the issue price) See instructions and attach schedule

If obligations are TANs or RANs, check box  If obligations are BANs, check box 

If obligations are in the form of a lease or installment sale, check box 

11 Education

12 Health and hospital

13 Transportation

14 Public safety

15 Environment (including sewage bonds)

16 Housing

Utilities

19

Other. Describe 

20

Description of Obligations. Complete for the entire issue for which this form is being filed.

(e) Yield (d) Weighted

average maturity (a) Final maturity date (b) Issue price (c) Stated redemptionprice at maturity

$ years %

Uses of Proceeds of Bond Issue (including underwriters’ discount)

Proceeds used for accrued interest 22

21

Issue price of entire issue (enter amount from line 21, column (b)) 23

22

Proceeds used for bond issuance costs (including underwriters’ discount) 24

23

Proceeds used for credit enhancement 25

24

Proceeds allocated to reasonably required reserve or replacement fund 26

25

Proceeds used to currently refund prior issues 27

26

29 Total (add lines 24 through 28) 29

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

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

Enter the remaining weighted average maturity of the bonds to be currently refunded  years 31

33 Enter the last date on which the refunded bonds will be called 

34 Enter the date(s) the refunded bonds were issued 

Miscellaneous

35 Enter the amount of the state volume cap allocated to the issue under section 141(b)(5)

37 Pooled financings: a Proceeds of this issue that are to be used to make loans to other governmental units

b If this issue is a loan made from the proceeds of another tax-exempt issue, check box  and enter the name of the

issuer  and the date of the 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 issuer’s authorized representative Date Type or print name and title

For Paperwork Reduction Act Notice, see page 2 of the Instructions. Form 8038-G (Rev. 11-2000)

Part VI

Part III

Part V

Part IV

Part I

Part II

Cat. No. 63773S

 

Room/suite

39 If the issuer has elected to pay a penalty in lieu of arbitrage rebate, check box 

11

12

13

14

15

16

35

37a

40 If the issuer has identified a hedge, check box 

28 Proceeds used to advance refund prior issues 28

Enter the remaining weighted average maturity of the bonds to be advance refunded  years 32

36a Enter the amount of gross proceeds invested or to be invested in a guaranteed investment contract (see instructions)

b Enter the final maturity date of the guaranteed investment contract 

36a

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

( )

17

18

17

18

$

27

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