Information Return for Tax-Exempt

Private Activity Bond Issues Form 8038

OMB No. 1545-0720

(Under Internal Revenue Code section 149(e)) Department of the Treasury

Internal Revenue Service © See separate instructions.

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

PA19 -

5 City, town, or post office, 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 for each) Issue Price

9 Exempt facility bond:

9a a Airport (sections 142(a)(1) and 142(c))

b Docks and wharves (sections 142(a)(2) and 142(c)) 9b

9c c Mass commuting facilities (sections 142(a)(3) and 142(c))

d Water furnishing facilities (sections 142(a)(4) and 142(e)) 9d

9e e Sewage facilities (section 142(a)(5))

9f f Solid waste disposal facilities (section 142(a)(6))

g Qualified residential rental projects (sections 142(a)(7) and 142(d)), as follows: 9g

Meeting 20–50 test (section 142(d)(1)(A))

Meeting 40–60 test (section 142(d)(1)(B))

Meeting 25–60 test (NYC only) (section 142(d)(6))

Has an election been made for deep rent skewing (section 142(d)(4)(B))? No Yes

9h h Facilities for the local furnishing of electric energy or gas (sections 142(a)(8) and 142(f))

9i i Local district heating or cooling facilities (sections 142(a)(9) and 142(g))

Qualified hazardous waste facilities (sections 142(a)(10) and 142(h)) 9j j

High-speed intercity rail facilities (sections 142(a)(11), 142(c), and 142(i)) 9k k

Check box if the owner elected not to claim depreciation or any tax credit (see instructions) ©

m Facilities allowed under a transitional rule of the Tax Reform Act of 1986 (see instructions) 9m

Facility type

1986 Act section

Qualified mortgage bond (section 143(a)) 10 10

Qualified veterans’ mortgage bond (section 143(b)) © 11 11

If you elect to rebate arbitrage profits to the United States, check box

Qualified small issue bond (section 144(a)) (see instructions) © 12 12

For $10 million small issue exemption, check box

Qualified student loan bond (section 144(b)) 13 13

Qualified redevelopment bond (section 144(c)) 14 14

Qualified hospital bond (section 145(c)) (attach schedule-see instructions) 15 15

16 16 Qualified 501(c)(3) bond other than a qualified hospital bond (attach schedule-see instructions)

17 Nongovernmental output property bond (treated as private activity bond) (section 141(d)) 17

18 Other. Describe (see instructions) © 18

Description of Bonds

(d)

Stated redemption

price at maturity

(e)

Weighted average

maturity

(g)

Net

interest cost

(f)

Yield

(c)

Issue price

(b)

Interest rate

(a)

Maturity date

19 Final maturity %$ $

20 Entire issue $ $ years % %

For Paperwork Reduction Act Notice, see page 1 of the Instructions. Form 8038 (Rev. 3-95)

Part III

Part I

Part II

Cat. No. 49973K

(Rev. March 1995)

Room/suite

Environmental enhancements of hydroelectric generating facilities (sections 142(a)(12) and

142(j))

l

9l

n Qualified enterprise zone facility bonds (section 1394) 9n
Form 8038 (Rev. 3-95) Page 2

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

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 (complete Part VI) 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 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:

a Land 29a

b Buildings and structures 29b

c Equipment with recovery period of more than 5 years 29c

d Equipment with recovery period of 5 years or less 29d

e Other (describe) 29e

30 Standard industrial classification (SIC) of the projects financed by nonrefunding proceeds.

SIC Code Amount of nonrefunding proceeds SIC Code Amount of nonrefunding proceeds

a c

b d

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

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

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

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

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)(B)(i)(III) ©

Volume Cap

38 Amount of volume cap allocated to the issuer. Attach copy of state certification 38

39 Amount of issue subject to the unified state volume cap 39

40 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, environmental

enhancements of hydroelectric generating facilities, or high-speed intercity rail facilities 40a

b Under a carryforward election. Attach a copy of Form 8328 to this return 40b

c Under transitional rules of the Tax Reform Act of 1986 40c

Enter the Act section of the applicable transitional rule ©

40d

Under the exception for current refunding (section 146(i) and section 1313(a) of the Tax Reform

Act of 1986)

d

41 Amount of issue of qualified 501(c)(3) bonds:

a Qualified hospital bonds 41a

b Qualified nonhospital bonds 41b

c Outstanding tax-exempt nonhospital bonds 41c

42a Amount of issue of qualified veterans’ mortgage bonds 42a

b Enter the state limit on qualified veterans’ mortgage bonds 42b

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

Name of above officer (type or print) Title of officer (type or print)

Part VIII

Part VII

Part VI

Part V

Part IV

Amount

Amount

© ©

36 Check box if you have elected to pay a penalty in lieu of rebate ©

$

$ $

$

37 Check box if you have identified a hedge (see instructions) ©

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