Form 8038-G OMB No. 1545-0720

Department of the Treasury

Internal Revenue Service

Reporting Authority If Amended Return, check here ©

1 Issuer’s name 2 Issuer’s employer identification number (EIN)

3 Number and street (or P.O. box if mail is not delivered to street address) 4 Report number (For IRS Use Only)

3

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

7 Name of issue 8 CUSIP number

Part I

(Rev. May 2010)

Room/suite

9 Name and title of officer of the issuer or other person whom the IRS may call for more information 10 Telephone number of officer or other person

( )

Information Return for Tax-Exempt Governmental Obligations

© Under Internal Revenue Code section 149(e)

© See separate instructions.

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

Type of Issue (enter the issue price) See instructions and attach schedule

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 (MM/DD/YYYY) ©

34 Enter the date(s) the refunded bonds were issued © (MM/DD/YYYY)

For Privacy Act and Paperwork Reduction Act Notice, see separate instructions. Form 8038-G (Rev. 5-2010)

Part III

Part V

Part IV

Part II

Cat. No. 63773S

11

12

13

14

15

16

28 Proceeds used to advance refund prior issues 28

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

17

18

17

18

$

27

If obligations are TANs or RANs, check only box 19a ©

If obligations are BANs, check only box 19b ©
Form 8038-G (Rev. 5-2010) Page 2

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. I further declare that I consent to the IRS’s disclosure of the issuer’s return information, as necessary 

to process this return, to the person that I have authorized above. Signature

and 

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

Form 8038-G (Rev. 5-2010)

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.

©

© ( )

Miscellaneous

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

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

governmental units 

37

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

issuer ©

Part VI

35

37a

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

(GIC) (see instructions)

b Enter the final maturity date of the GIC ©

36a

b

and the date of the issue ©

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

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

40 If the issuer has identified a hedge, check box ©