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

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

(Rev. May 1993) © See separate Instructions.

Department of the Treasury

Internal Revenue Service (Use Form 8038-GC if the issue price is under $100,000.)

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

G19 -

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

7 Name of Issue 8 CUSIP Number

Type of Issue (check applicable box(es) and enter the issue price)

9

If obligations are tax or other revenue anticipation bonds, check box ©

Issue price

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

10

Education (attach schedule–see instructions) $

11

Health and hospital (attach schedule–see instructions)

12

13

Transportation

Public safety

14

Environment (including sewage bonds)

15

Housing

16

Utilities

17

Other. Describe (see Instructions) ©

18

Description of Obligations

(g)

Net interest

cost

(e)

Weighted

average maturity

(d)

Stated redemption

price at maturity

(a)

Maturity date

(b)

Interest rate

(f)

Yield

(c)

Issue price

19 Final maturity %

20 Entire issue years % %

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

21 Proceeds used for accrued interest 21

22 Issue price of entire issue (enter amount from line 20, column (c)) 22

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

24 Proceeds used for credit enhancement 24

25 Proceeds allocated to reasonably required reserve or replacement fund 25

26 Proceeds used to refund prior issues 26

27 Total (add lines 23 through 26) 27

28 Nonrefunding proceeds of the issue (subtract line 27 from line 22 and enter amount here) 28

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

Enter the remaining weighted average maturity of the bonds to be refunded © years 29

30 Enter the last date on which the refunded bonds will be called ©

31 Enter the date(s) the refunded bonds were issued ©

Miscellaneous

32 Enter the amount of the state volume cap allocated to the issue ©

33 Enter the amount of the bonds designated by the issuer under section 265(b)(3)(B)(i)(III) (small issuer

exception) ©

34 Pooled financings:

a Enter the amount of the 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.

Please

Sign

Here Signature of officer Date Type or print name and title

For Paperwork Reduction Act Notice, see page 1 of the Instructions. Form 8038-G (Rev. 5-93)

Part VI

Part III

Part V

Part IV

Part I

Part II

Cat. No. 63773S

© ©

Room/suite

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