ram 8038

(Rev. April 1990)

Department of the Treasury
Internal Revenue Service

Information Return for Tax-Exempt

Private Activity Bond Issues
(Under Section 149(e))
> See separate instructions.

OMB No. 1545-0720
Expires 5/31/92

GEM) Reporting Authority cl

heck box if Amended Return > [_]

1 Issuer's name

2 Issuer's employer identification number

3 Number and street

4 Report number
PALS

5 City or town, state, and ZIP code

6 Date ofissue

7 Name of issue

8 CUSIP number

Type of Issue (check box(es) that applies and enter the Issue Price for each) Issue Price
9 Exempt facility bond:
all Airport (sections 142(a)(1) and 142(c)) 9a
b LC] Docks and wharves (sections 142(a)(2) and 142()) 9b
c CI Mass commuting facilities (sections 142(a)(3) and 142(c)) . 9c
a0 Water furnishing facilities (sections 142(a)(4) and 142(e)) 9d
el Sewage facilities (section 142(a)(5)) 9e
+ C1 Solid waste disposal facilities (section 142(aX6)) . Lot
g oO Qualified residential rental projects (sections 142(a)(7) and 142(@)), as follows: . 9
Meeting 20-50 test (section 142(d)(1)(A)) . .. Oo «
Meeting 40-60 test (section 142(d)(1)(B)) oO
Meeting 25-60 test (NYC only) (section 142(d)(6)) Oo
Has an election been made for deep rent skewing (section 142(4)(4\B)? OlYes LINo Mh
h C1] Facilities for the local furnishing of electric energy or gas (sections 142(a)(8) and 142(f)) 9h
i D Local district heating or cooling facilities (sections 142(a)(9) and 142(g)). » LG
j Oo Qualified hazardous waste facilities (sections 142(a)(10) and 142(h)). . i
kO High-speed intercity rail facilities (sections 142(a)(11), 142(c), and 142(i)) . . .. [9k
Check box if the owner elected not to claim depreciation or any tax credit (see instructions) . >
1 (C Facilities allowed under a transitional rule of the Tax Reform Act of 1986 (see instructions) . 91
Facility type
1986 Act section. Uh
10 O Qualified mortgage bond (section .. .. L210
Check box if you elect to rebate arbitrage profits tothe U.S. . |
11 (J) Qualified veterans’ mortgage bond (section 143(b)) ... pil
Check box if you elect to rebate arbitrage profits tothe U.S. . >
12 (J Qualified small issue bond (section 144(a)) (see instructions) - 2. [12
Check box for $10 million small issue exemption : >
13 (1 Qualified student loan bond (section 144(b)) . 13
14 (1 Qualified redevelopment bond (section 144(c)) . 14
15 (1 Qualified hospital bond (section 145(c)) 15
1s CJ Qualified 501(c)(3) bond other than a qualified hospital bond: (section 148). 16
Employer identification number (EIN) of the qualifying 501(c)(3) organization
va Nongovernmental output property bond (treated as private activity bond)(section 141(d)) 17
18 (1 Other. Describe (see instructions)»
18

izaguig Description of Bonds

® © © Stated eee Worghted © Net Rerest
Maturity date _ | Interest rate Issue price banat peal ete aeeevield sania
19 Final maturity . 961 $ $
20 Entire issue $ $ years| % %

For Paperwork Reduction Act Notice, see page 1 of the Instructions.

Form 8038 (Rev. 4-90)


Form 8038 (Rev. 4-90) Page 2

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

21 Proceeds used for accrued interest . : rrr 21

22 _ Issue price of entire issue (enter amount from line 20, column °). ee 4

23 Proceeds used for bond issuance costs (including underwriters’ discount). . | 23

24 Proceeds used for creditenhancement. . . . . . . (24 Y

25 Proceeds allocated to reasonably required reserve or replacement fund 2. [2h ]

26 Proceeds used to refund prior issues (complete PartVI) . . . . . . . L26 1]
27 Total (add lines 23, 24,25,and26). . . . woe ee L872

28 _Nonrefunding proceeds of the issue (Subtract line 27 from line 22 and enter amount here) ~. | 28

Description of Property Financed by Nonrefunding Proceeds

(Do not complete for qualified student loan bonds, qualified mortgage bonds, or qualified veterans’ mortgage bonds.)

29 Type of Property Financed by Nonrefunding Proceeds: Amount.

alan. .... 1

b Buildings and structures. on So ee ee. [29D

c Equipment with recovery period of more ‘than 5 years ee 2

d Equipment with recovery period of5yearsorless . 2... 1. 1 eee ee ee ee es [29d

e Other (describe) 29e
30 Standard industrial classification (Sic) of nonrefunding proceeds ‘for “the Financed projects.

SIC Code Nonrefunding proceeds $ SIC Code Nonrefunding proceeds $

—4 c

b d
Description of Refunded Bonds (complete this part only for refunding bonds)
31 Enter the remaining weighted average maturity of the bondstoberefunded . . 2... 1 ee ee years
32 Enter the last date on which the refunded bonds willbecalled 2. 1. ee ee ee ee

33 Enter the date(s) the refunded bonds were issued >

aay Miscellaneous

34 Name of governmental unit(s) approving issue (see instructions) >

35__Enter the amount of the bonds designated by the issuer under section 265(b)(3)(BY(i)(II)

ceed) Volume Cap Amount
36 Amount of volume cap allocated to the issuer. Attach state certification. . . . ..... . . (36
37 Amount of issue subject to the unified state volumecap . . eee ee. L387

38 Amount of issue not subject to the unified state volume cap or other volume limitations:
a Of bonds for governmentally owned solid waste facilities, airports, docks, wharves, or high-speed intercity

railfacilities. ©. . Se
b Undera carryforward election. Attach copy of Form 8328 to this return a 1)
¢ Under transitional rules of the Tax Reform Act of 1986 . 38c
Enter the Act section of the applicable transitional rule . Uf
d Under the exception for current refunding (section 1313(a) of the Tax Reform Actof 1986)... . . | 38d
39 Amount of issue of qualified 501(c)(3) bonds:
a Qualified hospitalbonds. 2 6 6. ke 39a
b Qualified nonhospitalbonds . . . . Co [9D
¢ Outstanding tax-exempt nonhospital bonds. Ce ee ee ee. [39
40a Amount of issue of qualified veteran's mortgagebonds. . . . . .. 1... ss ss ss (40a
b Enter the amount of the state veterans’ limit... . 40b
Under penalties of perury, [declare that Ihave examined This return, and accompanying schedules and statements, and tothe best of my Knowedge and belie,
they are true, correct, and complete.
Please
Sign ) smanea officer Dias
Here
Name of above officer (type or print) Title of officer (type or print)